Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York: Form Law School Certificate (06/2018) Page 1 of 3 Instructions: Applicant must complete the first portion of this form certificate, sign the form and send it to each law school listed by the applicant on the application for admission questionnaire (see question number 11). The law school should complete the remainder of the form and return it directly to the Appellate Division Department designated below by the applicant. TO BE COMPLETED BY APPLICANT: Name of Applicant þ BOLE ID # (NYS Board of Law Examiners Identification Number) þ Current Street Address (Office or Home) þ City/Town/Village þ State þ ZIP þ Country (if not USA) þ Telephone þ E-mail þ Social Security Number þ Name of School þ Address of School þ City/Town/Village þ State þ ZIP þ Country (if not USA) þ TO BE COMPLETED BY SCHOOL ONLY: Dates of Attendance at Law School From (mm/yyyy) þ To (mm/yyyy) þ Date Graduated from Law School (mm/yyyy) þ Degree Conferred by School þ AUTHORIZATION BY APPLICANTI (name of applicant), , hereby authorize (name of school) and persons issuing this certificate to release to the Dated (mm/dd/yyyy) B American LegalNet, Inc. www.FormsWorkFlow.com Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York: Form Law School Certificate (06/2018) Page 2 of 3 Designation of Appellate Division Department to Which School Should Mail Completed Form: þ First Judicial Department Committee on Character and Fitness, Appellate Division, First Department þ Second Judicial Department þ Third Judicial Department Attorney Admissions, Appellate Division, Third Department þ þ þ Appellate Division, Third Department Attorney Admissions þ þ þ Fourth Judicial Department Attorney Admissions, Appellate Division, Fourth Department American LegalNet, Inc. www.FormsWorkFlow.com Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York: Form Law School Certificate (06/2018) Page 3 of 3 TO BE COMPLETED BY SCHOOL ONLY:Please confirm whether or not the school information provided by applicant above is accurate. Yes No (if 223No224 please explain)Was applicant charged with any misconduct, or disciplined, suspended, or dropped for any misconduct? Yes No (if 223Yes224 please state fully) Yes No (if 223Yes224 please state fully) If applicant filed a questionnaire or written application containing data, please supply a copy thereof, if available. Official Seal of School Title of Official þ Dated (mm/dd/yyyy) IF THIS IS NOT IN ENGLISH, IT MUST BE ACCOMPANIED BY AN ENGLISH TRANSLATION THAT IS EITHER DULY AUTHENTICATED OR INCLUDES A STATEMENT BY THE TRANSLATOR SETTING American LegalNet, Inc. www.FormsWorkFlow.com