IOWA SUPREME COURT COMMISSION ON CONTINUING LEGAL EDUCATION JUDICIAL BRANCH BUILDING, 1111 EAST COURT AVENUE, DES MOINES, IOWA 50319 (515) 725-8029 Application for Waiver or Extension of Time to Complete Educational Requirement (Please type or print) Name: __________________________________________________________________________________ Address:__________________________________________________________________________________ ______________________________________________________ Zip: ________________________ E-Mail Address: ____________________________ (E-Mail is the preferred method of notifying you regarding your extension request.) Telephone No: ( ) Social Security No: _________________________ Year of Admission to Practice in Iowa: _______________ Commission ID: _________________________ A $25.00 fee is assessed on all waiver or extension of time applications received after January 15 of the year following the year in which the alleged hardship occurred. I hereby make application pursuant to Rule 42.5 of the regulations of the Commission. specifically your request and enclose additional sheets or supporting information if appropriate.) (Describe Hardship or Extenuating Circumstance(s): Relief Sought: I hereby certify that the facts set forth above are true and correct and that this application is made in good faith and not for the purpose of evading the requirement of Court Rules 41.3 or 42.2. Dated this day of , 20 . __________________________________________ Signature 4/25/03 American LegalNet, Inc. www.USCourtForms.com