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UNITED STATES DISTRICT COURT
D IS T R IC T O F CO N N EC T IC U T O FF IC E O F T H E C LE RK UNITED STATES COURTHOUSE 141 CHURCH STREET NEW HAVEN, CT 06510
T E L. NO . 7 7 3 -2 1 4 0 (AREA CODE 203)

Re: Application for Admission to the B ar of T his Court Each applicant must complete the attached petition for admission and the accompanying affidavit. (T hese must be typed, otherwise they will be returned.) T he applicant must include with the application a current certificate of good standing from a court to which he/she has been admitted to practice, the two (2) certificates in support of your application completed by two (2) members of the bar of this court and a $160.00 check made payable to: Clerk, U nited States District Court T he two sponsoring members of the bar must enter their date of admission to the U .S. D istrict Court, know you for at least six months, and they must enter their Connecticut federal bar number on the certificate. T hese also must be typed or they will be returned. It is important for you to include your telephone number, e-mail address and firm name and address in the office portion of the application. Failure to do so may result in the inability of this office to provide you with timely notice for your admission hearing. Applications must be submitted to the O ffice of the Clerk, U.S. District Court, 450 M ain Street, Hartford, CT 06103. It is not necessary to bring an attorney with you to move your admission. After your application has been reviewed and approved, you will receive a calendar to appear in court for your admission. You must appear in person at the appointed time and place. P lease check the calendar closely for the date, seat of court and courtroo m for the hearing. Admissions are held each month (except August), as follows: New Haven - First M onday Bridgeport - First Friday Hartford- Second M onday Robin D. Tabora Clerk of Court
R evis ed Feb ruary 1 3, 2 00 9

D ISTRICT O F CO N N ECTICU T PETITIO N FO R AD M ISSIO N (M U ST BE TYPED )

Petition of____________________________________ for adm ission as an attorney to the Bar of the U nited States D istrict Court for the District of Connecticut. I,_________________________________________________________do hereby petition the H onorable Judges of the U nited States District Court for the D istrict of Connecticut for adm ission to the Bar of the Court as an attorney, and I respectfully subm it to the Clerk of Court the follow ing inform ation required by Local Rule 83.1(b): 1. I reside at: ____________________________________________________________________; M y office address is: N am e of Firm : __________________________________________________________________________ Address:_________________________________________________________________________________ Phone N um ber: _____________________________ E-Mail Address: _____________________________ 2. I was adm itted to practice before the Bar of (list all courts, state and federal, of w hich you are a m em ber and the date(s) of adm ission: _____________________________________________ __________________________________________________________________________________________ _________________________________________________________________________ and rem ain an attorney in good standing. (Attach a certificate of good standing.) 3. I was previously adm itted as a pro hac vice attorney in the Connecticut U .S. District Court. M y assigned bar num ber is: ________________. 4. I received m y undergraduate degree from ________________________________________ in______________, with degree of_____________________________________________; I received the degree of J.D ., LL.B. or LL.M ., from _______________________________________________________ in__________________. 5. I have been engaged in the general practice of law in (the state or district)________________________________________________________________________from _______ ________________________,___________, to the present tim e.

6. I have studied carefully the jurisdictional provisions of Title 28, U .S.C., the Federal Rules of Civil Procedure, the Federal Rules of Crim inal Procedure, and the Local Rules of the U nited States D istrict Court for the District of Connecticut. 7. I have attached to this petition certificates executed by tw o m em bers of the Bar of the U nited States District Court for the D istrict of Connecticut, stating w here and when they were adm itted to practice in said Court, how long and under w hat circum stance they have know n m e, and what they know about m y character and experience at the bar. 8. I enclose a check for $160.00 payable to the Clerk of the U nited States D istrict Court to cover the applicable adm ission fee. D ated at__________________________________, ________________________, this _______________day of_____________________________, 20_______. ________________________________________________ Signature of Applicant ________________________________________________ Printed N am e of Applicant ________________________________________________ Street Address ________________________________________________ City and State

CERTIFICATE OF THE CLERK I, Roberta D. Tabora, Clerk of the U nited States District Court for the D istrict of Connecticut, do hereby certify that I have received and exam ined the petition for adm ission from the applicant and find it to be in full com pliance with the requirem ents of the Local Rules. Accordingly, the petition is hereby approved and filed. D ated at Hartford, Connecticut, this ______________day of ______________________20___________. Clerk, U . S. District Court

By______________________________________________ Deputy Clerk

(Revised February 13, 2009)

CERTIFICATE (MUST BE TYPED) TO: CLERK OF THE COURT I am writing you in support of the petition of ___________________________ for admission to the bar of the U.S. District Court for the District of Connecticut. I was admitted to the bar of the United States District Court for the District of Connecticut on: (Month, day, year)_______________________. I have known the petitioner for __________ years __________ months. I have known the petitioner under the following circumstances: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I know of the petitioner's character and experience at the bar, as follows: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I further certify that I know of no fact that would call into question the integrity or character of ________________________________________________________ Dated at __________________ this ________ day of ________________20____ _________________________
(Signature)

ct________________________
(Federal Bar No)

_________________________
(NAME PRINTED)

_________________________
FIRM

_________________________
ADDRESS

_________________________ _________________________

CERTIFICATE (MUST BE TYPED) TO: CLERK OF THE COURT I am writing you in support of the petition of ___________________________ for admission to the bar of the U.S. District Court for the District of Connecticut. I was admitted to the bar of the United States District Court for the District of Connecticut on: (Month, day, year)____________________________________. I have known the petitioner for __________ years __________ months. I have known the petitioner under the following circumstances: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I know of the petitioner's character and experience at the bar, as follows: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I further certify that I know of no fact that would call into question the integrity or character of ________________________________________________________ Dated at __________________ this ________ day of ________________20____ _________________________
(Signature)

ct________________________
(Federal Bar No)

_________________________
(NAME PRINTED)

_________________________
FIRM

_________________________
ADDRESS

_________________________ _________________________

ADDENDUM TO PETITION FOR ADMISSION TO THE BAR OF THE UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT AFFIDAVIT (MUST BE TYPED)

NAME OF APPLICANT Have you ever been denied admission to or disciplined by any Court, whether by way of disbarment, suspension from practice, censure or otherwise, or have you have ever previously resigned from the Bar of this Court? Yes No If your answer is "yes", please explain:

Have you ever been convicted of any crime other than a minor traffic offense? Yes No If answer is "yes", please provide a narrative of the events leading to your arrest and conviction, including information as to the sentence imposed:

__________________________ Signature of Applicant

Sworn and subscribed to before me this

day of

, 20

.

Notary Public

Please attach one current certificate of good standing from any of the following: Connecticut state court Connecticut bar association State wide grievance committee Member of another federal district court bar