Free Form: Admission to Practice - Federal

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Preview Form: Admission to Practice
219 S. Dearborn Street Chicago, Illinois 60604

APPLICATION FOR ADMISSION TO PRACTICE To be completed by Clerk's Office personnel. Date of OUT OF COURT Admission: __________________________________

Date of IN COURT Admission: _________________________ Admitting panel: ______________________________________ Applicant Information (Please type or print neatly.) APPLICANT'S NAME:____________________________________________________________________________________ SOCIAL SECURITY NUMBER: _____________________________________________________________________________ NAME OF FIRM OR AGENCY: _____________________________________________________________________________ BUSINESS ADDRESS: ____________________________________________________________________________________ _________________________________________________________________________________________________________ BUSINESS TELEPHONE NUMBER: ________________________________________________________________________ DATE FIRST ADMITTED (TO ANY BAR): ___________________________________________________________________ STATE(S) IN WHICH APPLICANT IS ADMITTED TO PRACTICE: _______________________________________________ ________________________________________________________________________________________________________ HAVE YOU EVER RECEIVED ANY FORM OF DISCIPLINE (INCLUDING A PRIVATE REPRIMAND OR A SANCTION) FROM A COURT OR A LAWYERS DISCIPLINARY AUTHORITY SINCE YOU WERE FIRST ADMITTED TO PRACTICE LAW? ___________________________________________________________________________________________________ IF THE ANSWER IS OTHER THAN NO, PLEASE STATE ON AN ATTACHED SHEET WHAT HAPPENED AND INCLUDE A COPY OF EACH RELEVANT ORDER. Fee Information Circuit Rule 46. Attorneys (b) Admission Fees. The prescribed fee for admission is $15.00, except that attorneys who have been appointed by the district court or this court to represent a party on appeal in forma pauperis, law clerks to judges of this court or the district courts, and attorneys employed by the United States or any agency thereof need not pay the fee. Checks should be made payable to the Clerk as "Trustee of the Lawyers Fund". Check applicable box(es):

9 Fee Enclosed


9 Fee Waived: 9 Appointed counsel in this court 9 Attorney employed by federal government

I hereby certify that the above information is correct and complete. Further, I hereby certify that I have read the "STANDARDS FOR PROFESSIONAL CONDUCT WITHIN THE SEVENTH FEDERAL JUDICIAL CIRCUIT" and agree to conduct myself in accordance therewith. Finally, I solemnly swear that I will demean myself as an attorney and counselor of this court, uprightly and according to law; and that I will support the Constitution of the United States. ____________________________________________________ (Signature of Applicant) ________________________________________________________________________________________________________ Sponsor Information SPONSOR'S NAME: ______________________________________________________________________________________ WHEN ADMITTED TO PRACTICE: _________________________________________________________________________ WHEN ADMITTED TO THIS COURT: _______________________________________________________________________ I hereby vouch for the personal integrity and professional ethics of the applicant and respectfully move that said applicant be admitted as an attorney and counselor of this court. ____________________________________________________ (Signature of Sponsor)
Reproduction of this form is authorized. (April 2000)