UNITED STATES DISTRICT COURT, NORTHERN DISTRICT OF ILLINOIS, EASTERN DIVISION Plaintiff(s) ) ) V. Defendant(s) Case Number: ) ) Judge: ) MOTION FOR APPOINTMENT OF COUNSEL [NOTE: Failure to complete all items in this form may result in the denial of this motion] 1. I, , declare that I am the (check appropriate box) plaintiff defendant in the above-entitled proceeding and state that I am unable to afford the services of an attorney, and hereby request the Court to appoint counsel to represent me in this proceeding. 2. In support of my motion, I declare that I have contacted the following attorneys/organizations seeking representation (NOTE: This item must be completed): but I have been unable to find an attorney because: 3. In further support of my motion, I declare that (check appropriate box): I am not currently, nor previously have been, represented by an attorney appointed by the Court in this or any other civil or criminal proceeding before this Court. I am currently, or previously have been, represented by an attorney appointed by the Court in the proceeding(s) described on the back of this page. 4. In further support of my motion, I declare that (check appropriate box): I have attached an original Application for Leave to Proceed In Forma Pauperis in the proceeding detailing my financial status. I have previously filed an Application for Leave to Proceed In Forma Pauperis in this proceeding, and it is a true and correct representation of my financial status. I have previously filed an Application for Leave to Proceed In Forma Pauperis in this proceeding. However, my financial status has changed and I have attached an Amended Application to Proceed In Forma Pauperis to reflect my current financial status. American LegalNet, Inc. www.FormsWorkflow.com 5. (Check one box) In further support of my motion, I declare that my highest level of education is: Grammar school only Some high school High school graduate Some college College graduate Post-graduate 6. (Check only if applicable) In further support of my motion, I declare that my ability to speak, write, and/or read English is limited because English is not my primary language 7. (Check only if applicable) In further support of my motion, I declare that this form and other complaint forms were prepared with the help of an attorney from the U.S. District Court Pro Se Assistance Program. 8. I declare under penalty that the foregoing is true and correct. Movant’s Signature Street Address Date City, State, ZIP As indicated in paragraph three on the preceding page, I am currently, or previously have been, represented by an attorney appointed by this Court in the civil or criminal actions listed below. Assigned Judge: Case Number: Case Title: Appointed Attorney’s Name: If this case is still pending, please check box Assigned Judge: Case Number: Case Title: Appointed Attorney’s Name: If this case is still pending, please check box Assigned Judge: Case Number: Case Title: Appointed Attorney’s Name: If this case is still pending, please check box American LegalNet, Inc. www.FormsWorkflow.com