(Rev. 03/20/12) FOR OUT OF STATE ATTORNEYS ONLY INSTRUCTIONS FOR PETITIONERS APPLYING FOR ENROLLMENT TO PRACTICE LAW IN THE UNITED STATES DISTRICT COURT, EASTERN AND WESTERN DISTRICTS OF ARKANSAS A written application must be filed with the Clerk of Court in order to be admitted to practice in the United States District Courts for the Eastern and Western Districts of Arkansas. For this purpose, the attached Petition for Enrollment must be completed. Each applicant is required to answer all of the questions on the Personal History Statement. This information is necessary for the court to determine your qualifications. The statement must bear your signature and be acknowledged before a Notary or other official authorized to administer oaths. In addition, your Petition for Enrollment must be accompanied by an original certificate of good standing from the Clerk of the State Supreme Court from the state where you principally practice law and from the Clerk of the United States District Court where you are enrolled. Your Petition for Enrollment, Personal History Statement, Certificate of Good Standing and $186.00 fee, which includes a $176.00 enrollment fee and a $10.00 biennial assessment for the "Library Fund" pursuant to Local Rule Appendix XI, should be mailed or presented to the: Clerk of Court United States District Court Eastern District of Arkansas 600 West Capitol Avenue, Room A149 Little Rock, Arkansas 72201 If your petition and all supporting documents are in order, a Certificate of Enrollment will be sent to you by return mail. If you have any questions, please call the Office of the Clerk at (501) 604-5351. ______________________ 1 Hereafter, the “Library Fund” fee will be assessed and collected on a biennial basis; the biennial assessment fee is $10.00. (Distribute Only During Even Fiscal Years) American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT EASTERN AND WESTERN DISTRICTS OF ARKANSAS PETITION FOR ENROLLMENT ____________________________________, Ex Parte TO THE HONORABLE JUDGE OF THE DISTRICT COURT OF THE UNITED STATES FOR THE EASTERN AND WESTERN DISTRICTS OF ARKANSAS Your petitioner respectfully shows to the Court that I am over the age of twenty-one years and of good moral character; that I possess the requisite qualifications of learning and ability to practice as an attorney and counselor at law in this Court and that I am regularly enrolled as an attorney and counselor at law in the state Supreme Court where I reside. I am also in good standing in the United States District Court(s) where I am enrolled. Wherefore, petitioner prays the Honorable Court to enter an order authorizing me to practice as an Attorney at Law in this Court. _______________________________________ Petitioner APPROVED BY: _______________________________________ United States District Judge ____________________________ Date Approved DATE FEE PAID _______________ RECEIPT NO. _________________ Official Use Only Verification Check by Date _______________________________ American LegalNet, Inc. www.FormsWorkFlow.com PERSONAL HISTORY STATEMENT 1. Name: __________________________________________________________________ 2. Home Address: __________________________________________________________ 3. Firm Name:______________________________________________________________ Street Address: __________________________________________________________ P.O. Box: ______________________________________________________________ City/State/Zip: _____________________________________Telephone: ____________ 4. Supreme Court Registration Number: ________________________________________ 5. Place of Birth: ___________________________________________________________ 6. Date of Birth: ____________________________________________________________ 7. Are you in sound physical and mental condition? ________________________________ 8. What has been your occupation during the past five years? ________________________ _______________________________________________________________________ 9. Have you ever been discharged from any position? _________ If so, for what reason? _______________________________________________________________________ 10. Have you ever been arrested and/or convicted for any breach or violation of law other than traffic offenses? _____________ If so, please describe: _____________________ _______________________________________________________________________ 11. Have you ever been sued? _________ If so, give particulars: _____________________ _______________________________________________________________________ 12. Give three references: Name Occupation Address _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 13. Education: Name and Location of School Dates Attended Degree _______________________________________________________________________ _______________________________________________________________________ Other studies and training for legal profession: ________________________________ _______________________________________________________________________ 14. Are you now working in State or Federal Government? __________________________ 15. Are you now actively engaged in the practice of law? ____________________________ 16. List a telephone number where you may be reached for purposes of notification regarding this petition: __________________________ 17. Do you want a Court Technology Card pursuant to General Order 54? Yes No I certify that I have read and understand the Local Rules of this Court and that I agree to attend all conferences set by the Court or I shall associate local counsel to attend in my absence. __________________________________ Applicant NOTARY SUBSCRIBED AND SWORN TO before me by the above-named applicant this ______ day of _______________, 20_____. __________________________________ Notary Public My commission expires: ______________ American LegalNet, Inc. www.FormsWorkFlow.com ATTORNEY’S OATH I, ________________________________, do solemnly swear (or affirm) that I will conduct and demean myself as an attorney of this Court, uprightly and according to law, and that I will support and defend the Constitution of the United States, so help me God. __________________________________ Applicant NOTARY SUBSCRIBED AND SWORN TO before me by the above-named applicant this ______ day of _______________, 20_____. __________________________________ Notary Public My commission expires: ______________ American LegalNet, Inc. www.FormsWorkFlow.com