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* Date Format: MM slash DD slash YYYY Member #Name* First Last Home Address* Street Address City State / Province / Region ZIP / Postal Code Cell Phone*Email* 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*Supervisor's Fax Number*Date of adverse action (if applicable) Date Format: MM slash DD slash YYYY Have you utilized an internal grievance process?*YesNoHas a hearing, board meeting or meetings with your supervisor been scheduled?*YesNoIf 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.