APPLICATION FOR CERTIFICATION - SENIOR LAW STUDENT 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 a law student at ________________________ School of Law has received credit for work representing at least one-half of the total hourly credits required for graduation from the law school, is a student in good academic standing, and is eligible under the school's criteria to undertake the activities authorized by Illinois Supreme Court Rule 711. The above named student is expected to graduate on _____________________. Date ____________________________________ 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 for me by: Student's Name Full Name of Agency Agency Address City/State/Zip Code Agency Telephone Number Supervising Attorney's Name and ARDC Number (Must be a member in good standing of the Illinois bar) 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 __________________________________________ Dated this ________ day of ___________________ , ________ Supervising Attorney's Signature / Student 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