APPLICATION FOR CERTIFICATION - LAW SCHOOL GRADUATE ILLINOIS SUPREME COURT RULE 711 To: Administrative Office of the Illinois Courts 222 North LaSalle Street, 13th Floor Chicago, Illinois 60601 Attach TWO Recent 1" x 1-1/2" Photos THIS CERTIFIES THAT (please print or type): First Name Middle Initial Last Name Social Security Number Street Address City/State/Zip Code ( E-Mail Address ) Telephone Number graduated from ________________________ School of Law on _____________________ . Date I have received a copy of this application for licensing under Illinois Supreme Court Rule 711 and I have no objection to this graduate being authorized to perform the services described in Rule 711(c). ______________________________________ Dean of Law School Signature Certified by the above named school this _________ day of ______________ , ___________ . (SCHOOL SEAL) The services authorized by Illinois Supreme Court Rule 711, which I acknowledge I have read, will be performed under my supervision by: Graduate's name Full Name of Agency Agency Address City/State/Zip Code ( ) Supervising Attorney's Name and ARDC Number (Must be a member in good standing of the Illinois bar) Agency Telephone Number The Agency indicated above is (check appropriate box): A legal aid bureau, legal assistance program, organization or clinic chartered by the State of Illinois or approved by a law school approved by the American Bar Association The Office of the Public Defender A law office of the state or any of its subdivisions __________________________________________ Supervising Attorney's Signature Dated this ________ day of ___________________ , _________. Multi-State Professional Responsibility Examination (MPRE) I have not yet sat for the MPRE I have sat for and received a passing grade for the MPRE* * Failure to earn a passing grade on the MPRE precludes the approval and/or continued practice authorized by Supreme Court Rule 711. / Graduate Certification (Signature)/Date For office use only: Approved by : ______________ I have previously applied for a Rule 711 license: Yes No Date: ______________ Expiration date: ______________ Rev. 7/13 American LegalNet, Inc. www.FormsWorkFlow.com