Arizona School Administrators

Legal Services Request Form

The Active member’s request must include a full and truthful statement of fact respecting the problem and must indicate the inability to obtain satisfactory assistance from the school district. Approval from the ASA Executive Director must be granted prior to contacting a law firm or attorney. It is the member’s responsibility to be familiar with the ASA Legal Services Process and Requirements.

ASA Legal Services Process & Requirements *

I have read and agree to the Process & Requirements for legal services

Date *

Name

First *

Last *

Home Address

Street Address *

City *

State / Province / Region

ZIP / Postal Code *

Cell Phone *

Employer (School District) *

Employer Address *

Street Address

City

State / Province / Region

ZIP / Postal Code

Current Position *

Annual Salary *

Length of Time with Employer *

Name of Immediate Supervisor & Title *

Supervisor's Email *

Supervisor's Phone Number *

Date of adverse action (if applicable)

Have you utilized an internal grievance process? *
Choose 1

Has a hearing, board meeting or meetings with your supervisor been scheduled? *
Choose 1

If Yes, When? Where?

Describe the reason(s) you are seeking legal advice/services *

Upon submitting this form the Active member will receive a communication within two working days to discuss their request for legal services and the approval to contact an attorney for the initial consultation. Reminder, if approved it is the members' responsibility to pay the attorney at the time of service and provide the "paid" invoice to ASA to receive reimbursement within 10 working days.