United States District Court for the Northern District of Illinois PETITION FOR ADMISSION TO THE TRIAL BAR A. GENERAL INFORMATION LAST NAME FIRST NAME MIDDLE NAME/INITIAL 1 2 PETITIONER'S NAME Identification number (Illinois ARDC number or number issued by another State Bar) 3 OTHER NAMES USED BY PETITIONER NONE LAST NAME FIRST NAME MIDDLE NAME/INITIAL LAST NAME FIRST NAME MIDDLE NAME/INITIAL STREET ADDRESS 4 ADDRESS OF PETITIONER'S RESIDENCE CITY COUNTY STATE ZIP FIRM OR BUSINESS NAME 5 ADDRESS OF PETITIONER'S LAW FIRM STREET ADDRESS ROOM NUMBER CITY COUNTY STATE ZIP 6 PETITIONER'S DAYTIME TELEPHONE NUMBER YES AREA CODE ( ) 7 IS PETITIONER CURRENTLY A MEMBER IN GOOD STANDING OF THE BAR OF THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS? Date Admitted IS PETITIONER FILING FOR ADMISSION TO THE GENERAL BAR OF THE COURT SIMULTANEOUSLY WITH FILING THIS PETITION? NO YES NO B. PARTICIPATION UNITS Petitioner participated as the lead counsel or as the assistant to the lead counsel in each of the following 1 NAME OF COURT DATES OF TRIAL NAME OF PRESIDING JUDGE SHORT TITLE OF CASE PARTY REPRESENTED BY PETITIONER LENGTH OF TRIAL IN DAYS (NET OF TIME TAKEN IN VOIR DIRE AND MOTIONS IN LIMINE) 2 NAME OF COURT DATES OF TRIAL NAME OF PRESIDING JUDGE SHORT TITLE OF CASE PARTY REPRESENTED BY PETITIONER American LegalNet, Inc. www.FormsWorkFlow.com LENGTH OF TRIAL IN DAYS (NET OF TIME TAKEN IN VOIR DIRE AND MOTIONS IN LIMINE) 3 NAME OF COURT DATES OF TRIAL NAME OF PRESIDING JUDGE SHORT TITLE OF CASE PARTY REPRESENTED BY PETITIONER LENGTH OF TRIAL IN DAYS (NET OF TIME TAKEN IN VOIR DIRE AND MOTIONS IN LIMINE) 4 NAME OF COURT DATES OF TRIAL NAME OF PRESIDING JUDGE SHORT TITLE OF CASE PARTY REPRESENTED BY PETITIONER LENGTH OF TRIAL IN DAYS (NET OF TIME TAKEN IN VOIR DIRE AND MOTIONS IN LIMINE) 5 NAME OF COURT DATES OF TRIAL NAME OF PRESIDING JUDGE SHORT TITLE OF CASE PARTY REPRESENTED BY PETITIONER LENGTH OF TRIAL IN DAYS (NET OF TIME TAKEN IN VOIR DIRE AND MOTIONS IN LIMINE) C. OBSERVATION UNITS Petitioner has observed the following qualifying trials under the supervision of a member of the trial bar of this court and consulted with that member about it: DATES OF TRIAL 1 NAME OF COURT SHORT TITLE OF CASE LAST NAME FIRST NAME MIDDLE NAME/INITIAL NAME OF SUPERVISING ATTORNEY FIRM OR BUSINESS NAME ADDRESS OF SUPERVISING ATTORNEY STREET ADDRESS ROOM NUMBER CITY COUNTY STATE ZIP DATES OF TRIAL 2 NAME OF COURT SHORT TITLE OF CASE LAST NAME FIRST NAME MIDDLE NAME/INITIAL NAME OF SUPERVISING ATTORNEY American LegalNet, Inc. www.FormsWorkFlow.com FIRM OR BUSINESS NAME ADDRESS OF SUPERVISING ATTORNEY STREET ADDRESS ROOM NUMBER CITY COUNTY STATE ZIP D. SIMULATION UNITS Petitioner has participated in the following simulated trial which is recognized by the Court as being adequately supervised: NAME OF INSTITUTION, ASSOCIATION, ETC. NAME ANDADDRESS OF INSTITUTION CONDUCTING THE SIMULATED TRIAL STREET ADDRESS ROOM NUMBER CITY COUNTY STATE ZIP 1 NAME OF PERSON SUPERVISING SIMULATION TYPE OF SIMULATION AND DATE(S) HELD I, the above-named, have filed a petition for admission to the Trial Bar of the Court. In further support of my petition I do solemnly swear (or affirm) as follows: (a) I have read each of the answers given in the petition and they are true and correct; (b) I have read Local Rule 83.11 of this Court, as amended, concerning the criteria for admission to the Trial Bar, including without limitation the provisions defining the nature of a testimonial proceeding and of a qualifying trial for which credit units will be granted; (c) Each and every one of the trials or hearings listed in my petition for which I have requested participation units meets the requirements of the Rules; and (d) I have read Local Rules 83.11(g) and 83.11(h) concerning the duties of members of the Trial Bar and will faithfully perform such duties when called upon to do so. I declare under penalty of perjury that the foregoing is true and correct. Date Signature Under 28 U.S.C. §1746, this declaration under penalty of perjury has the same force and effect as a sworn declaration made under oath. American LegalNet, Inc. www.FormsWorkFlow.com FOR OFFICE USE ONLY (Fee Stamp) B1 C1 D1 +B2 +C2 +D2 +B3 + +B4 Total or 2 = TOTAL whichever is less . . . . . . . . . . . TOTAL Checked by Deputy Date Rev. 12/28/2016 American LegalNet, Inc. www.FormsWorkFlow.com