Application For Admission To Practice

Supreme Court of the United States APPLICATION FOR ADMISSION TO PRACTICE (Please do not submit attachments unless instructed to do so) Fill out form online and print Name as you want shown on your Certificate: First Name: Middle Name: Firm Name: Address: City: Office Phone: Email Address: 1. 2. 5. City and state you want shown on your Certificate. Date of birth: Residence Address: City: 6. Name of parents: (a) Mother's full maiden name (b) Father's name 7. State court(s) of last resort to which you are admitted to practice, and date(s) of admission. State Court Date of Admission State Court Date of Admission Last Name: Suffix: State: Alternate Phone: Zip Code: Check this box if you want the alternate Certificate described in the instructions. City: 4. Place of birth: State: 3. Social Security No: State: Zip Code: 8. Yes No Are you engaged in the practice of the law? State the nature of your practice, whether by self, in partnership, or associated with or employed by others, giving the name of the firm or employer. 9. List firms or other entities with which you have been formerly associated, or by which you have been employed, as a lawyer. 10. Undergraduate and legal education and when and where degrees received. School Degree Location Date Received 11. Have you ever changed your name or been known by any name or surname other than those appearing on this application? If so, state and give details. Yes No 12. (a) Have you ever been disciplined, disbarred, sanctioned, or suspended from practice before any court, department, bureau, or commission of the United States, or of any State, Commonwealth, Territory, Possession, or the District of Columbia, or have you received any public or private No Yes reprimands from any such entity pertaining to your conduct as a member of the bar? No Yes (b) Are there any disciplinary proceedings presently pending against you? (c) Have you been denied admission to the bar of this Court or the bar of any entity described in (a) No Yes above? No Yes (d) Have you been convicted of a crime? (other than a minor traffic violation) (e) If you answered "yes" to any of the questions in this paragraph you must provide a detailed explanation on a separate sheet and attach any relevant documentation concerning your answer. COMPLETE CERTIFICATION ON FOLLOWING PAGE American LegalNet, Inc. www.FormsWorkFlow.com First Name: Last Name: Social Security No: CERTIFICATION I certify that I have read the foregoing questions and have answered them fully and frankly. The answers are complete and are true to my own knowledge. Date (Applicant's Signature) STATEMENT OF SPONSORS We, Title First Name Last Name Middle Initial Suffix and Title First Name Last Name Middle Initial Suffix , being members of the Bar of the Supreme Court of the United States and not related to the applicant, state that the applicant is personally known to us, that the applicant possesses all the qualifications required for admission to the Bar of the Supreme Court of the United States, and that we have examined the applicant's personal statement and believe it to be correct, and we affirm that the applicant's moral and professional character and standing are good. (Signature) Office Address: Office Address: (Signature) City: State: Zip Code: City: State: Zip Code: OATH OF ADMISSION I, , do solemnly swear (or affirm that as an attorney and as a counselor of this Court I will conduct myself uprightly and according to the law, and that I will support the Constitution of the United States. Date (Applicant's Signature) COMPLETE THE FOLLOWING ONLY IF ADMISSION IS ON WRITTEN MOTION (NOT IN OPEN COURT) MOTION FOR ADMISSION I, (Movant's name is to be entered as it appears on movant's Certificate of Admission to this Court) , a member of the Bar of the Supreme Court of the United States, hereby move the admission of to the Bar of the Supreme Court of the United States. I am satisfied the applicant possesses the necessary qualifications. Date (Movant's Signature) CLER-0079-5-07 American LegalNet, Inc. www.FormsWorkFlow.com