U.S. District Court (Rev. 05 / 2019 ) - Attorney Admission Application Page 1 of 2 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND ATTORNEY ADMISSION APPLICATION **Unless otherwise noted, all questions and fields must be completed or your application will be rejected.** N AME F IRM /A GENCY N AME A DDRESS C ITY , S TATE Z IP P HONE N O . F AX N O . E - M AIL A DDRESS A. BACKGROUND QUESTIONNAIRE If you answer yes to any of these questions , you must submit a statement under the penalty of perjury stating the relevant facts, court, charge, date, whether the occurrence was disclosed to the highest court of the state(s) in which you are admitted, dis position, whether the occurrence was an isol ated incident, and any other facts you deem relevant. The Court may confirm the accuracy of any submitted information by conferring with the appropriate court or bar authority , if applicable . 1. Are there any disciplinary proceedings pending against y ou? YES NO 2a. Have you been denied admission to practice, disbarred, suspended from practice, or disciplined by any court or bar authority , other than administrative suspensions for non - payment of bar dues ? YES (answer 2.b) NO (skip to 3) 2b. If you have been suspended or disbarred from the practice of law by any court or bar authority, have you been reinstated? YES NO N /A 3. Have you ever resigned from the practice of law in any court in order to avoid disciplinary action or while the subject of any pending investigation, action, or proceeding involving allegations of misconduct or the commission of a crime ? YES NO 4. Excluding traffic violations punishable by fine only, have you ever been convicted of, or entered a plea of no contest to, any crime or are any criminal charges pending against you? YES NO 5. Have you eve r been held in contempt of court? YES NO c ontinued on the next page American LegalNet, Inc. www.FormsWorkFlow.com U.S. District Court (Rev. 05 / 2019 ) - Attorney Admission Application Page 2 of 2 B. PRO BONO QUESTIONNAIRE As a member of the bar of this Court you are expected to handle cases on a pro bono basis when called upon to do so by the Co urt. Please answer the following questions so that your skills and preferences may be taken into account when you ar e appointed to a case. 1a. Are you employed by a government agency? Yes (answer 1 b & 1 c) No (skip to 2) 1 b. What is the name of your agency ? 1c. Does your agency preclude you from accepting a pro bono appointment in a civil case? Yes (skip to Part C) No (go on to 2) 2. I n what types of civil cases do you prefer to be appointed ? Prisoner Civil Rights Civil Litigation Employment Discrimination Bankruptcy ERISA Social Security C. 1. I have been admitted to practice law in the following state (including the District of Columbia) and federal courts : S TATE OR F EDERAL C OURT D ATE OF A DMISSION S TATE OR F EDERAL C OURT D ATE OF A DMISSION 2. Unless otherwise indicated in Section A, I am an active member in good standing of the bars of each of the above listed jurisdictions. 3. I am familiar with the Maryland Rules of Professional Cond uct, the Federal Rules of Civil Procedure, the Federal Rules of Evidence, the Federal Rules of Appellate Procedure, the Local Rules of the United States District Court for the District of Maryland , and (to the extent relevant to my area(s) of practice) the Federal Rules of Criminal Proc edure, the Federal Rules of Bankruptcy Procedure, and the Local Bankruptcy Rules. 4. Except when employed by a government agency that precludes accepting a pro bono appointment, I am willing to accept court appointments to represent indigent parties in c ivil cases in this district. 5. My principal law office is located in (city, state) and located in the United States District Court for the . 6. I ha ve reviewed the l ocal r ules of each U.S. District Court of which I am a member and I have determined that membership in the bars of those districts do es not disqualify me from membership in the bar of this Court pursuant to the reciprocity provision of Loc al Rule 701.1.c. 7. I understand that it is my responsibility to promptly update my contact information in CM/ECF or to notify Attorney Admissions of any change in my name or address. I further understand that my failure to promptly update my contact information may affect my ability to practice in this Court . See Local Rule 701.3. 8. I understand that I will be required to renew my membership in the bar of this Court periodically. I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. Signature: Date: American LegalNet, Inc. www.FormsWorkFlow.com U.S. District Court (Rev . 2/2012 ) Page 1 of 2 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND 1. I, , was admitted to the bar of this court on (refer to http://www.mdd.uscourts.gov . Click on Attorney Admissions tab; bullet labeled Bar Membership Information ) and I am presently a member in good standing of this bar. My bar number is ( ref er to http://www.mdd.uscourts.gov . Click on Attorney Admissions tab; bullet labeled Bar Membership Information ) . I am moving the admission of . 2. I believe the applicant is a member in good standing of the bar of a state or the District of Columbia and is otherwise qualified for admission to the bar of this court. I am willing to assist the applicant in learning the standards, practices and procedures of the court. 3. TO BE COMPLETED IF YOU HAVE KNOWN THE APPLICANT AT LEAST ONE YEAR I have known the applicant for at least one year. My relationship with the applicant has been as follows: 4. TO BE COMPLETED IF YOU HAVE KNOWN THE APPLICANT LESS THAN ONE YEAR Attached is a resume of the applicant along with the names and contact information of two reference s known the applicant since , and the two references have confirmed to me that the applicant has sufficient knowledge, sk ills, and abilities as an attorney. In addition to the references, American LegalNet, Inc. www.FormsWorkFlow.com U.S. District Court (Rev . 2/2012 ) Page 2 of 2 I believe that the applicant is qualified to be a member of the bar of this court because (you may provide a supplemental sheet if needed) I certify under the penalties of perjury that the foregoing statements are true and correct. Date Signature Printed Name Firm Name Address City, State, Zip Code Main Firm Telephone Number Fax Number ********************************************** ******************************** WAIVER (Required only if paragraph 4 is completed.) Granted Denied Date United States District/Magistrate Judge American LegalNet, Inc. www.FormsWorkFlow.com