Free Certification of Eligibility for Admission - West Virginia

CERTIFICATION OF ELIGIBILITY FOR ADMISSION
Date of Admission: Place of Admission: Time of Admission: Presiding Judge:

Attorney Name: Employer: Employer Address: Employer Phone: Email: Fax: Attorney moving admission: Employer: Employer Address:

WV Bar Number:

Employer Phone: Email: Moving Attorney permitted to practice before US District Court for the Northern District of West Virginia? Are you presently fully admitted to the WV state bar with no disciplinary restrictions? If you currently have disciplinary restrictions, please explain:

(Add an attachment if necessary) Have you ever been disciplined by any bar of any state: If Yes, please explain when, why, and by what state:

(Add an attachment if necessary) Please list some general information about yourself (where you will practice, schooling, etc.):

Mandatory: Complete and present this form to the appropriate Clerk's office at least one week before the date of your admission.