UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF NORTH CAROLINA DIVISION IN RE: CASE NO: DEBTOR APPLICATION FOR APPROVAL OF MENTAL HEALTH EVALUATION The debtor, , respectfully requests the court to approve a pro bono or low cost mental health evaluation for use in this bankruptcy proceeding, and shows the court the following: 1. The debtor222s mental health is a genuine issue in these bankruptcy proceedings for the following reason(s): The debtor contends that the debtor222s mental health is relevant to the debtor222s failure to attend the meeting of creditors or other hearings. The debtor contends that the debtor222s mental health is relevant to allegations related to challenges to the debtor222s general discharge (section 727) or arguments for an exception to discharge (section 523). The debtor seeks to discharge student loans based upon mental illness under section 523(a)(8) or 42 U.S.C. 294g. The debtor seeks to avoid a default judgment based upon excusable neglect. The debtor seeks to exempt a personal injury award related to the debtor222s mental health, and that exemption has been challenged. Other (explain): 2. On information and belief, the debtor should be examined by a mental health professional to determine whether the debtor may have a recognized medical condition that would impact the issue(s) identified in paragraph 1. 3. Based upon the bankruptcy schedules and the debtor222s available income and assets, the debtor is currently unable to pay for a mental health evaluation that is necessary and relevant to the bankruptcy issues presented. 4. A copy of this application has been transmitted to the Bankruptcy Administrator and to the following interested party(ies): American LegalNet, Inc. www.FormsWorkFlow.com WHEREFORE, the debtor respectfully requests the court to approve a pro bono or low cost mental health evaluation in this case. This day of , 201. American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF NORTH CAROLINA DIVISION IN RE: CASE NO: DEBTOR ORDER APPROVING APPLICATION FOR MENTAL HEALTH EVALUATION Based upon the Application for Approval of Mental Health Evaluation filed by the debtor and representations contained therein, the court approves the debtor222s request for a pro bono or low cost mental health evaluation for purposes of this action. The court will hold a status conference to discuss the use of the evaluation during the bankruptcy case and at trial. Notice of the status conference will be issued by the Clerk of Court. Pursuant to EDNC LBR 2014-2, this order and any subsequent order appointing a mental health professional shall be restricted from public access. END OF DOCUMENT American LegalNet, Inc. www.FormsWorkFlow.com