UNITED STATES DISTRICT COURT WESTERN DISTRICT OF WASHINGTON OFFICE OF THE CLERK U.S. COURTHOUSE, SUITE 2310 700 STEWART STREET SEATTLE, WASHINGTON 98101 (206) 370-8400 WILLIAM M. MCCOOL District Court Executive Clerk of Court LORI LANDIS Chief Deputy Clerk APPLICATION FOR LEAVE TO APPEAR AS A LEGAL INTERN Pursuant to LCR 83.4 of the United States District Court for Western District of Washington, ____________________________________________________hereby applies for permission to appear and participate as a legal intern under the supervision of Attorney ________________________________________________________. I am a student duly enrolled and in good academic standing at __________________________________________ and I have completed: _____ two-thirds of my three year course of study _____ five-eighths of my four year course of study; OR Nine months have not expired since my graduation from law school at _____________________________________________ and I have attached proof thereof. I understand that I am charged with knowing and complying with the Washington State Rules of Professional Conduct and Local Rules of the United States District Court for the Western District of Washington. I declare under penalty of perjury that the foregoing is true and correct. _____________________________________ Signature of Applicant U.S. District Court ­ Legal Intern Application Revised March 13, 2015 American LegalNet, Inc. www.FormsWorkFlow.com Supervising Attorney's Name: _________________________________ WSBA____________ Firm Name: _________________________________________________________________ Address: ____________________________________________________________________ Phone Number: _______________________________________________________________ STATEMENT OF SUPERVISING ATTORNEY I am prepared to supervise the applicant in accordance with Local Rule GR2(i)4). I certify that I am admitted to practice before this Court; and that I have been actively engaged in the practice of law for at least three years. DATED this ________ day of ________________________, 20__. _____________________________________ Signature of Supervising Attorney ORDER It is ordered that the application to appear as a legal intern is hereby approved. DATED this ________ day of _________________________, 20__. _____________________________________ United States Magistrate Judge Submit completed Application for Leave to Appear as a Legal Intern to: United States District Court Western District of Washington Attn: Dana Scarp ­ Admissions Clerk 700 Stewart Street, Suite 2310 Seattle, WA 98101 U.S. District Court ­ Legal Intern Application Revised March 13, 2015 American LegalNet, Inc. www.FormsWorkFlow.com