UNITED STATES DISTRICT COURT WESTERN DISTRICT OF NEW YORK NOTICE TO ALL ATTORNEYS SEEKING ADMISSION IN THE WESTERN DISTRICT According to Local Rule of Civil Procedure 83.1(g), "Every member of the bar of this Court shall be available upon the Court's request for appointment to represent or assist in the representation of indigent parties." PLEASE BE ADVISED the Court shall select attorneys for appointment on indigent cases from those attorneys who have been admitted to federal court for one year or more, or possess equivalent experience. To facilitate selection in the future, the Court requires you to provide it with the following information. Name: Law Firm: Address: Telephone: Fax: E-mail: Date: Admitted to Practice: (please provide the year of admission) New York State: Federal Court: District(s) Litigation/Trial Experience: (Check any that apply and add the approximate number of each) ________ Lead Counsel (Case Settled Before Trial) (Number of State ____ Federal ____) ________ Second Chair (Case Settled Before Trial) (Number of State ____ Federal ____) ________ Lead Counsel at Trial (Number of State ____ Federal ____) ________ Second Chair at Trial (Number of State ____ Federal ____) Are you proficient in a second language? Yes ____ No ____ If so, state which language: Availability: ________ ________ ________ ________ ________ I am willing to accept my assignment now. I am actively involved in current litigation, call me: ____ in three months ____ in six months I am willing to supervise another attorney. I would like to second chair another attorney on a Federal Court matter during the next six months if possible, before accepting my assignment. I currently have a federal pro bono matter (Docket No. ) Primary Areas of Practice: Assignment Preferences: (The Court will attempt to match assignments to preferences as often as possible, although it cannot guarantee that it will do so.) G G G G G G Civil Rights / Prisoner Civil Rights Employment Discrimination: G Title VII G ADA Social Security Diversity Actions Habeas Corpus: G 28 U.S.C. § 2241 G 28 U.S.C. § 2254 Other: (please specify) G ADEA G 28 U.S.C. § 2255 ATTORNEYS ARE REMINDED OF THEIR OBLIGATION UNDER LOCAL RULE OF CIVIL PROCEDURE 83.1(h) TO NOTIFY THE COURT OF ANY CHANGE IN NAME, FIRM AFFILIATION, OFFICE ADDRESS OR TELEPHONE NUMBER WITHIN THIRTY DAYS OF SUCH CHANGE. American LegalNet, Inc. www.USCourtForms.com