GAL/Child Representative Information Sheet (Application for Family or Juvenile Appointment as guardian ad litem or Child Representative) I, ________________________________, after being duly sworn, under oath state as follows: 1. I am a licensed attorney in the State of Illinois and in good standing with the Attorney Registration and Disciplinary Commission. 2. I have attended the education program created by and/or presented by an approved MCLE provider consisting of a minimum of ten hours of continuing legal education credit within the two (2) years prior to the date of my application. 3. I hereby certify that I am currently covered by professional liability insurance which would cover any and all claims against me arising out of my legal services as guardian ad litem and/or Child Representative in family or juvenile cases. I agree to maintain such coverage as long as I remain on the family or juvenile appointment list. 4. I understand that I am subject to receive appointment from this Court to serve on a pro bono basis, at least one (1) time each year. 5. understand that at the conclusion of my appointment on each case, I must submit to the Court a Petition for Fees to seek reimbursement of my legal services as guardian ad litem and/or Child Representative, and that the Court must approve fee requests and determine which parties or individuals are responsible for payment of fees. 1. I hereby certify that all of the statements contained herein are within my own personal knowledge, and hereby apply for appointments in family or juvenile law cases as guardian th ad litem and/or Child Representatives for the 17 Judicial Circuit. My office address and phone number is as follows: Address: Phone: SUBSCRIBED AND SWORN to before me this _____ day of ______________________, 20 . Notary Public Signature Date Attorney Number APPROVED: Authorizing Judge Date Rev: 07/2009 APPENDIX II American LegalNet, Inc. www.FormsWorkFlow.com