APPLICATION FOR MEMBERSHIP ON THE TENTH CIRCUIT APPELLATE CRIMINAL JUSTICE ACT (CJA) ATTORNEY PANEL Instructions To be considered for membership on the appellate CJA attorney panel for the Tenth Circuit Court of Appeals an attorney must be, or become, and remain a member in good standing of the court's bar and familiar with the court's CJA Plan, must demonstrate knowledge of and experience in federal criminal law and appellate procedure, and must be committed to indigent criminal defense. Counsel on the appellate panel must be willing to accept at least one appellate CJA appointment per year. To apply for membership on the Tenth Circuit’s appellate CJA attorney panel, submit the following materials in pdf format to CJA_Vouchers@ca10.uscourts.gov This questionnaire, fully completed, A current resume, and An appellate brief you authored. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED Page 5 is left blank for your use; please feel free to attach additional pages if needed. Direct any questions regarding this application to either the Clerk of Court (303.844.3157) or the Court's CJA Supervising Attorney, (303.335.2846). You may also want to contact your local representative on the court's CJA Standing Committee: Chairman Raymond Moore, CO-WY FPD; Liz Harris (Colorado); Cyd Gilman (KS FPD); Scott Davidson (NM); Jim Drummond & William Lunn (OK); Ann Taliaferro (UT); or Michael Reese (WY). Name: Firm, if any: Office Address (St & Ste): Office Address (City, State, ZIP): Phone No. E-mail Address: Fax No. Cell No. Best Way to Contact: Page 1 of 5  American LegalNet, Inc. www.FormsWorkFlow.com 1. Education & Degrees (undergraduate, graduate and law school, and honors, if any) 2. Bar Admissions (List each court and date admitted, incl. 10th Cir. if current member) 3. Disciplinary Actions Have you ever been disciplined, or are you the subject of any pending disciplinary proceeding, in the bar of any court (state or federal)? Yes No Has any court ever held that you provided ineffective assistance of counsel? Yes If you answered "yes" to either question, please explain the circumstances and the outcome of the proceedings (use p. 5 or attach separate page if needed). No N/A 4. Experience Have you ever been a member of a CJA panel, or member of a comparable state court panel? Yes No If yes, list the court(s) and approximate dates of service: N/A   Page 2 of 5  American LegalNet, Inc. www.FormsWorkFlow.com Describe the nature of your appellate experience. In particular, please provide the number of appellate briefs you have filed (both civil and criminal) in the last 5 years, and the Tenth Circuit case numbers for any briefs filed in this court in the last 5 years: Briefly describe any other federal experience that you believe relevant to your qualifications to serve on the Tenth Circuit's Appellate CJA Attorney Panel: 5. Other Have you ever been employed as a prosecutor, public defender, law clerk, or Yes No judge or justice? If so, please describe the position, and provide the name of your employer and the approximate dates of service: N/A 6. References Please list the names, addresses, and telephone number of two legal references who can assess your skills relevant to this appellate CJA panel attorney application.   Page 3 of 5  American LegalNet, Inc. www.FormsWorkFlow.com 7. Special Qualifications Are you fluent in Spanish? Yes In any other language? No No Yes If yes, which other language(s)? In which languages other than English are you able to interact with your client in writing without the aid of a translator? Verbally without the aid of an interpreter? Do you have a particular area of legal expertise such as immigration law, habeas corpus, white collar fraud, Indian law, death penalty or capital habeas? No Yes If yes, please explain: 8. Availability Occasionally appellate panel attorneys are asked to accept a case from a 10th Circuit district other than that in which the attorney has offices or resides. Assuming that you are not required to undertake any district court representation that might ensue from a successful appeal, will you accept appeals from other districts? Yes No From which district courts of the Tenth Circuit will you not accept cases? Colo Kan N.M. N.Ok W.Ok E.Ok Utah Are there any district courts or district court judges from which you cannot accept cases due to a conflict? (e.g., for whom you law clerked?) Wyo Yes No If yes, which districts or judges? 9. Signature and Date I certify that the information contained in this application is correct to the best of my knowledge. I also certify that I reviewed the court’s Criminal Justice Act Plan (Addendum I to local rules, http://www.ca10.uscourts.gov/clerk/rulesandforms.php), have a working knowledge of federal criminal law and appellate procedure, and am competent to accept membership on the Tenth Circuit’s Appellate CJA Attorney Panel. (If you do not yet use a digital signature, please type in your full name) Signature   Date: Page 4 of 5  American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 5    American LegalNet, Inc. www.FormsWorkFlow.com