Electronic 06/15 (Local Civil Rule 83.1/Criminal Rule 57.1) PETITION FOR ADMISSION UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF MICHIGAN 1. 2. Name: ____________________________________________________________________ FIRST / MIDDLE / LAST Firm Name: Business Address: ROOM / SUITE / FLOOR / BUILDING STREET ADDRESS CITY/ STATE / ZIP Business Telephone Number: 3. Identify all states (including the District of Columbia) in which you have been admitted to practice before the state's highest court, the date of admission, and whether you are in active status and good standing in that jurisdiction. If you are not in active status and good standing, explain on an attached sheet. Jurisdiction 1. _______________________ 2. _______________________ 3. _______________________ 4. _______________________ 5. _______________________ 6. _______________________ Date ____________ ____________ ____________ ____________ ____________ ____________ Active Status & Good Standing? _______ _______ _______ _______ _______ _______ Bar Number __________ __________ __________ __________ __________ __________ American LegalNet, Inc. www.FormsWorkFlow.com 4. Identify all federal courts (Supreme Court, Circuit Courts, District Courts, specialty courts) in which you have been admitted to practice, the date of admission, and status. If you are not in active status and good standing, explain on an attached sheet. Court Date Active Status & Good Standing? _______ _______ _______ _______ _______ _______ Bar Number 1. _______________________ 2. _______________________ 3. _______________________ 4. _______________________ 5. _______________________ 6. _______________________ ____________ ____________ ____________ ____________ ____________ ____________ __________ __________ __________ __________ __________ __________ 5. Have you ever been held in contempt of court or otherwise subjected to discipline as defined by the Local Rules of the Western District of Michigan? If so, nature and disposition thereof: *Pursuant to Local Civil Rule 83.1(d)(iii) and Criminal Rule 57.1(d)(iii), if an applicant has been subject to discipline, this petition must be accompanied by a copy of the entire disciplinary record, including complaints, answers, hearing transcripts and orders entered in the disciplinary proceedings. 6. Have you ever been convicted of any felony or misdemeanor? (You need not report a misdemeanor conviction occurring before commencement of law school.) If so, explain the facts and circumstances: American LegalNet, Inc. www.FormsWorkFlow.com 7. G I am newly admitted to the State Bar of be granted except in extraordinary circumstances. and request a waiver of the sponsorship requirement. [One year or less from time of application.] No other waivers will 8. 9. 10. G I will make electronic payment of the $205.00 admission fee as instructed by the Clerk. G I have read the Local Rules of the Western District of Michigan (www.miwd.uscourts.gov). G This application is continued on an attached page. I swear (or affirm) that the above information is accurate and correct to the best of my knowledge and belief. DATED SIGNATURE OF APPLICANT Statement of a sponsoring attorney of the Bar of this court, stating when the sponsoring attorney was admitted to practice in this court, under what circumstances the attorney has known the applicant, that the attorney knows the applicant to be of good character and reputation, and that the attorney believes the applicant to be well qualified as a member of the Bar of this court. For applicants residing in another state, the sponsor may be a judge of a court of record of that state, or a federal judge. SPONSORING ATTORNEY'S NAME SIGNATURE OF SPONSORING ATTORNEY OR JUDGE DATED STATE BAR I.D. NO. American LegalNet, Inc. www.FormsWorkFlow.com 12/13  9 9 9 9 American LegalNet, Inc. www.FormsWorkFlow.com