Expression of interest Pro Bono service provider

EOI Pro Bono Service Provider

Cancer Council WA is committed to supporting West Australians affected by cancer with their legal and financial issues and is introducing a state-based program Pro Bono program. We are establishing a network of providers who can provide Pro Bono support for those impacted by cancer. Please complete the EOI if you are able to support us in this program. If you require any further information at this stage, please don't hesitate to call our Pro Bono Program Coordinator on 08 6389 7810 or via email css-probono@cancerwa.asn.au.

Company name(Required)

Company address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Name(Required)

First Last

Position/Title(Required)

Phone(Required)

Email(Required)

Scope of Pro Bono Legal services offered(Required)

Wills

Power of Attorney & Guardianship

Other

Do not provide legal services

If other, please specify below

Scope Pro Bono Financial services offered(Required)

Early access to super

Access to insurance payments (attached to super and stand-alone policies)

Centrelink advice and assistance with paperwork

Debt management

Other

Do not provide financial services

If other, please specify below

How often would you prefer to receive referrals?(Required)

How many referrals would you like to receive during this time?(Required)

If other please specify below(Required)

Have you previously been associated with the national Pro Bono Program(Required)

Yes

If you would like to provide any further information please include below.

By providing my personal information and submitting an application, I agree that my information will be used and disclosed by Cancer Council WA in accordance with their Collection Statement and Privacy Policy.