UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT Thurgood Marshall U.S. Courthouse 40 Foley Square, New York, NY 10007 Telephone: 212-857-8500 CM/ECF PRO SE FILING USER REQUEST FORM Case name: _________________________________________________ Docket No.:______________ (Use short caption) Pro se party contact information: Name: Address: Phone: E-mail: _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Please list all courts in which you have filed documents electronically through CM/ECF: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Please list all CM/ECF instruction training you have received: Date(s) Court Instruction/Training Received _____________ _____________ _____________ _____________________ _____________________ _____________________ ________________________________ ________________________________ ________________________________ Technical Requirements: Type of computer you will be using: Version of Java installed: Screen resolution of computer’s monitor: Version of Adobe Acrobat installed: Scanning equipment available: ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ Certification: I, ________________________________________, do hereby acknowledge that I have read the Second Circuit CM/ECF instructions in detail, understand how to file a document electronically through CM/ECF, and agree to comply with all court instructions and FRAP and local rules regarding electronic case filing in the Second Circuit. If at any time the clerk deems my filing in CM/ECF unsatisfactory, my electronic filing privileges may be revoked, and I will be required to file documents in paper in accordance with FRAP 25 and LRs 25.2 and 25.3. ______________________________________________ Signature ____Approved ____Denied _______________________ Date By:______________________________ American LegalNet, Inc. www.FormsWorkFlow.com