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Trademark Clinic | Request for Representation

A professor talking with a student in the courtyard

Request for Representation

Please complete this form to request pro bono legal services from the USPTO Trademark Clinic at California Western School of Law.

PLEASE NOTE: submitting this form does not create an attorney/client relationship.

Client and Business Information

Client Name

Phone

Address

City

State

ZIP

Business Name

Type of Business Organization

State of Formation/Incorporation

Business Phone

Business Email

Address

City

State

ZIP

Website

Business Description

(e.g. goods or services you offer or intend to offer, where you sell (or intend to sell) your goods or provide your services, steps you have already taken)

Are you currently selling your goods or providing services?

Yes
No

If yes, when was the first use of your trademark on your goods or services?

Please enter the date, where applicable.

If yes, when was your first out-of-state sale or transaction?

Please enter the date, where applicable.

If no, when do you anticipate being in a position to offer your services or sell your goods?

Please enter the date, where applicable.

Mark Information

What is your planned trademark?

If it is a design mark, please be prepared to provide a clear JPEG or PDF version upon successful receipt of your submission.

What goods or services do you plan to use your mark on, or are already using your mark on?

How do you currently—or plan to—use the mark in relationship to your goods or services?

(e.g. on a hang-tag, internal printed label on a t-shirt, as a header on a webpage where customers can request services, etc.)

Financial or Special Eligibility Information

Please do not provide any personally identifying information regarding your finances. Our clinic provides pro bono legal services to qualified applicants. To be considered for legal representation, your gross income must be equal to or less than the USPTO Standard for Micro Entities (currently $177,117 but subject to change by the USPTO). Please indicate below whether you meet this income threshold. We reserve the right to withdraw from legal representation if we discover that your responses below were not accurate.

Is your gross income from all sources equal to or less than $177,117 per year?

Yes
NoCalifornia Western School of Law is not responsible for any personal, sensitive, or financial data not explicitly requested as a requirement for this clinic.

Electronic Signature

By signing below, I affirm that: 1) All the above information is true and correct; 2) I have a good faith belief that I meet the financial eligibility threshold; and 3) I understand that all services of the California Western School of Law USPTO Trademark Clinic are provided by students enrolled in the clinical course who are granted a provisional license to practice by the United States Patent and Trademark Office under the supervision of licensed attorney.

Signature

Date

Completing this form does not establish an attorney-client relationship with the California Western School of Law USPTO Trademark Clinic. We will not begin representation or undertake any work for you until a conflict check has been completed, we mutually decide to enter into an attorney-client relationship, and your Engagement Agreement has been signed, confirmed, and returned to the clinic’s supervising attorney.