UNITED STATES DISTRICT COURT for the EASTERN DISTRICT of MISSOURI APPLICATION FOR ADMISSION TO PRACTICE LAW **Please PRINT or TYPE** Name (First , Middle Initial, Last ) _________________________________________________________________ Home Address: ___________________________City: _______________________ ST: ____ Zip: ______________ Home Phone: ____________________ Date of Birth: __________________ Social Security #: _________________ Law School: _________________________________________________ Year Graduated: ___________________ Personal Email Address: __________________________________________ REGULARLY ENGAGED IN THE PRACTICE OF LAW AT: Firm Name: __________________________________________________________________________________ Address : ___________________________________________________________________________ Phone: __________________________ Ext.: ___________ Fax #: ____________________________________ Primary Email Address:__________________________________________________________________________ Secondary Email Address: _______________________________________________________________________ LIST STATE TO WHICH YOU ARE ADMITTED TO PRACTICE LAW: STATE YR. ADMITTED CURRENT STATUS I.D. NUMBER _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Please include current* certificates fo good standing from each jurisdiction listed above. LIST FEDERAL COURTS TO WHICH YOU ARE ADMITTED TO PRACTICE LAW: COURT YR. ADMITTED CURRENT STATUS _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Please include current* certificates fo good standing from each jurisdiction listed above. *Must be issued no more than 60 days prior to submitting application. American LegalNet, Inc. www.FormsWorkFlow.com APPLICANT'S NAME ANSWER THE FOLLOWING QUESTIONS "YES" OR "NO" IN THE BLANK PROVIDED. IF "YES" EXPLAIN IN FULL ON NEXT PAGE. Yes No 9 9 1. Have you ever been denied admission to the bar of any state (including the District of Columbia) or any federal court? 9 9 2. Have you ever been disbarred, suspended from practice, reprimanded, censured or otherwise disciplined or disqualified as an attorney? 9 9 3. Has any adverse action, formal or informal, been taken against you or your license to practice law, suspended or revoked by any grievance committee, court or other attorney disciplinary body? 9 9 4. Have you ever held a bonded position in connection with which anyone has sought to recover on your bond, or made a claim for any alleged default? 9 9 5. Have you ever been charged with violation of any criminal law, other than minor traffic violations? 9 9 6. Have you ever been charged with the commission of fraud, in any civil, criminal, bankruptcy, or administrative proceeding? 9 9 7. Have you ever been denied a discharge in bankruptcy, or had your discharge in bankruptcy revoked? 9 9 8. Are there any unsatisfied judgments against you, whether barred by limitation or not? - 2 American LegalNet, Inc. www.FormsWorkFlow.com APPLICANT’S NAME: Explanation(s) to Questions 1-8 American LegalNet, Inc. www.FormsWorkFlow.com APPLICANT’S NAME__________________________ ACKNOWLEDGMENT of OBLIGATION REGARDING APPOINTMENTS I understand that by signing this application I agree upon admission to the bar of the Eastern District of Missouri, to represent without compensation, indigent parties in civil matters when so ordered by a judge of the Court, and to accept appointments by a judge to represent indigent criminal defendants under the Criminal Justice Act unless exempt by rule or statue, except when such representation would create a conflict of interest. AFFIRMATION I swear/affirm that the information provided in the foregoing application is true and correct. I further affirm any required original certificates of good standing are currently maintained in my office and will be maintained for a period of 90 days. I acknowledge that by accepting admission to this court I am subjecting myself to the discipline of this court. I further certify that I have read and am familiar with the Federal Rules of Civil Procedure, the Federal Rules of Criminal Procedure, and the Local Rules of this court. By registering under this rule, attorneys consent to electronic service by the court of all documents, including orders and judgments. See Local Rule 5-2.12, Fed.R.Civ.P. 5, Fed.R.Civ.P. 77, and Fed.R.Crim.P. 49. ___________________________________ Date ____________________________________ Signature Subscribed and Sworn to Before Me this ________ day of ____________________, ______ at _______________________. ____________________________________ Notary Public or Deputy Clerk of this Court American LegalNet, Inc. www.FormsWorkFlow.com