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Application For Membership On Civil Trial Assistance Panel Form. This is a Indiana form and can be use in District Court Federal.
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Tags: Application For Membership On Civil Trial Assistance Panel, Indiana Federal, District Court
UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
APPLICATION FOR MEMBERSHIP ON CIVIL TRIAL ASSISTANCE PANEL
I,
, having been admitted to practice before the
United States District Court for the Southern District of Indiana and being a member in
good standing of the Bar of such Court, do hereby apply for membership in the Civil
Trial Assistance Panel of that Court. In support of this Application, I have supplied the
following information:
Full Name:
Firm or Business:
__
Business Address: _
Business Telephone:
Fax: __________________________
Specialized Area of Law (if any):
_
Year of Admission to the Southern District of Indiana: __
Email Address:________________________________________________________________
Please rank, in order of preference (“1" being the most preferred, “5" being the least
preferred), your preference for accepting a case which involves the following types of
matters:
Employment discrimination action
Civil rights action filed by person in custody
Other civil rights action
Social Security appeal
Other action - state preference:
If you are able to consult and advise in languages other than English, please indicate
below:
G
Spanish
G
Other:
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Please indicate your preference as to level of involvement:
__________ Handle entire litigation through trial, or if not, would prefer to:
__________ Assist litigant with limited phase of case, such as formation of
pleadings or discovery
__________ Assist litigant with making and responding to dispositive motions
(e.g. motion to dismiss, motion for summary judgment)
__________
Serve as stand-by counsel at trial
__________ Assist another attorney who has primary responsibility for case
__________
Seek involvement after summary judgment ruling
Please check below if you would you consider:
__________ Sharing responsibility for a case with another lawyer
Please indicate all Divisions of this Court in which you are willing to accept a case:
G
G
Indianapolis
Evansville
G
G
Terre Haute
New Albany
In making this Application, I represent that I am willing to represent civil
litigants determined to be eligible for representation under any applicable statutory
authority and for whom the request for counsel has been made pursuant to Rule 4.6 of
the Local Rules of the United States District Court for the Southern District of Indiana. I
recognize that I may decline a request by the Court for representation of an individual,
but I will make a reasonable effort to accept a request when I am able to do so. In
addition, I shall supplement this Application, in writing, from time to time as requested
by the Court and as circumstances warrant so as to keep the Court informed of any
change in my address or other information relevant to my membership on the Civil
Trial Assistance Panel.
Date:
Signature:
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For use by the Court
, 20
Appointed to Civil Trial Assistance Panel of Attorneys on
Member of sub-panel for the
Execute original only and return to:
Division.
Kristine Seufert
United States Courthouse, Room 105
46 East Ohio Street
Indianapolis, Indiana 46204
If you have any questions, please call (317) 229-3950.
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