UNITED STATES DISTRICT COURT DISTRICT OF NEW HAMPSHIRE APPLICATION FOR MEMBERSHIP OR SUBPANEL RECLASSIFICATION CRIMINAL JUSTICE ACT PANEL PERSONAL: Name:__________________________________________________________________ Firm Name:_____________________________________________________________ Office Address:__________________________________________________________ _______________________________________________________________________ Office Telephone No:_________________ Fax Number:_______________________ Email Address:__________________________________ Bar No:________________ PANEL MEMBERSHIP REQUEST: ” ” ” General Panel Complex and Major Crimes Panels First Response Panel ” ” Complex Panel Major Crimes Panel Only MINIMAL QUALIFICATIONS: I certify that over the past twelve (12) months I have satisfied the below CLE requirement and that over the next two (2) years I will satisfy all of the following membership requirements. ” I will complete the following CJA Membership CLE requirements: If I have served on the Complex/Major Crimes Panel in the immediate past 3 years or represented six (6) criminal defendants in this district during the same time period, I will attended all CJA training programs presented in this district over the next two (2) years; otherwise, I will annually complete a minimum of six (6) hours of training or a continuing legal education program on federal criminal defense, including at least three (3) hours devoted to the sentencing guidelines. ” I will maintain professional liability insurance in the minimum amount of $100,000/$300,000. ” I have experience in and knowledge of the Federal Rules of Criminal Procedure, the Federal Rules of Evidence, the Local Rules of this court, and the Federal Sentencing Guidelines and will remain current on any amendments to those rules, procedures and guidelines. USCDNH-23 (02-07)(previous editions obsolete) American LegalNet, Inc. www.FormsWorkflow.com GENERAL INFORMATION: 1. I am a member of the bar of the United States District Court for the District of New Hampshire and I am a member of good standing of that Court. I was admitted to practice before this Court on ____________________________________________. 2. I have also been admitted to practice in the following Courts: Date Admitted Name of Court _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. I have been engaged in the active practice of law since _________________________. 4. Have you ever been disciplined by any bar association or court? Yes ” No ” If yes, explain. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 5. Has any court ever determined that you have rendered ineffective assistance of counsel in a case? Yes ” No ” If yes, explain. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 6. Estimate what percentages of your total time in legal work during the last seven years concerned: Federal civil law matters ___% Federal criminal law matters ___% State civil law matters ___% State criminal law matters ___% Other ___% 2 American LegalNet, Inc. www.FormsWorkflow.com 7. Have you ever been employed as prosecutor, public defender, contract attorney for the State of New Hampshire or other equivalent position in another state, or law clerk to a judge? Yes ” No ” If yes, please indicate the position, the name of the office or judge, and dates of service/employment. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 8. List any Continuing Legal Education experience within the past 3 years, either as a lecturer or participant, regarding the Federal Sentencing Guidelines or criminal/trial advocacy programs applicable to federal criminal practice. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 9. Please briefly describe any other activity or experience you have had which bears on your qualifications to serve as CJA counsel (i.e., other teaching, bar activities, writing). _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 10. Do you have any specialized legal training, expertise or other skills that would make you more qualified to handle certain types of cases? Yes ” No ” If yes, please list (e.g., immigration, accounting, tax, intellectual property, foreign language proficiency, etc.). _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3 American LegalNet, Inc. www.FormsWorkflow.com PRIOR PANEL EXPERIENCE: 11. Are you a past or present member of this district’s CJA Panel? Yes ” No ” If yes, please list the dates of panel membership. _______________________________________________________________________ _______________________________________________________________________ 12. Have you at any time been a member of a CJA panel for any other court? Yes ” No ” If yes, please list the panel, dates of membership and the types of cases you were permitted to accept. __________________________________________________________________________ __________________________________________________________________________ 13. Have you ever been removed from, or not renewed for, any CJA panel or list? Yes ” No ” If yes, please provide details regarding the circumstances surrounding your removal or non-renewal. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ CRIMINAL TRIAL EXPERIENCE: 14. List the last five (5) criminal jury trials you have handled on an attached sheet. Please list the case name, court, trial judge, opposing counsel, offense charged and level of offense, length of trial and your role as trial counsel (i.e. lead, co-counsel, second chair, standby counsel, etc.). 15. List the last five (5) federal pleas and sentencings that you have handled on an attached sheet. Please list the case name, court, opposing counsel, offense charged and level of offense, your role as counsel (i.e. lead, co-counsel, second chair, standby counsel, etc.). 16. List five (5) additional criminal matters you carried to final disposition in state or federal court (motion, habeas corpus, mandamus, plea of guilty or other disposition, etc.) on an attached sheet. Please list the case name, court, opposing counsel, offense charged and level of offense, your role as counsel (i.e. lead, co-counsel, second chair, standby counsel, etc.). 4 American LegalNet, Inc. www.FormsWorkflow.com 17. List any federal judge before whom you have tried a criminal case. If less than three, list up to three state judges before whom you have tried a case. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 18. Please provide any additional information of which the Court should be aware in considering your application but which has not been discussed above. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ REFERENCES: Please list three persons who are familiar with your trial skills and qualifications to become a panel member whom may be contacted for a reference: Phone Number Name 1. ________________________________________ _______________________________ 2. ________________________________________ _______________________________ 3. ________________________________________ _______________________________ I have carefully read the foregoing application and certify that the information is true and correct to the best of my knowledge. ______________________________________ SIGNATURE OF APPLICANT ___________________________________ DATE 5 American LegalNet, Inc. www.FormsWorkflow.com FOR PANEL SELECTION COMMITTEE USE ONLY 9 9 9 9 9 General Subpanel Complex Subpanel Complex and Major Crimes Major Crimes only First Response Subpanel 9 9 9 9 9 9 9 9 9 9 Eligible Eligible Eligible Eligible Eligible Ineligible Ineligible Ineligible Ineligible Ineligible The PSC recommends placement on the: ” General ” Major Crimes Only ” Complex ” First Response ” Complex & Major If the PSC does not recommend placement on the subpanel requested by the applicant, please state the reasons below: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ FOR CLERK'S OFFICE USE ONLY Application reviewed by judge; approved/disapproved Applicant notified Entered in automated program Labels List Date: _______________________ By: _____________________________ Deputy Clerk 6 American LegalNet, Inc. www.FormsWorkflow.com