UNITED STATES COURT OF APPEALS FOR THE FOURTH CIRCUIT APPLICATION FOR ADMISSION TO THE BAR Instructions: Only attorneys admitted to the bar of the United States Court of Appeals for the Fourth Circuit may practice before the Court. In accordance with Fourth Circuit Rule 46(b), an attorney who is admitted to practice before the highest court of a state and who is of good moral and professional character may become a member of the bar by: 1. providing the information requested below; 2. having a member of the bar of the Court move admission by signing the Motion for Admission; 3. swearing or affirming the Oath before the clerk, a deputy clerk, a notary public or the Court (admission by personal appearance before the Court is usually reserved for ceremonial occasions); 4. paying the admission fee of $221.00 by credit card through CM/ECF or by check made payable to "Clerk, United States Court of Appeals." (The fee is waived for attorneys appointed to represent a party in forma pauperis, law clerks to federal judges within this Circuit, and counsel for the United States or any agency thereof who have a case pending before the Court. If a fee waiver is sought, add the Fourth Circuit docket number here: ); and 5. submitting the completed form through CM/ECF or mailing the completed form and check to the Clerk of the United States Court of Appeals, 1100 E. Main Street, Suite 501, Richmond, VA 23219-3517. NAME (present practicing name): Last First Generation (Jr., Sr., II, III, etc.) Prefix (Mr., Mrs., Miss, Ms., Professor, etc.) STATE OF RESIDENCE (for use on your certificate): FIRM: BUSINESS ADDRESS: Title (if applicable) Middle City State Fax ( ) Year Zip Code - Phone ( E-mail ) Ext. YEAR OF BIRTH: _______ PLEASE COMPLETE PAGE TWO OF THIS FORM ECF Hard Copy 12/01/2016 swv/scc Receipt No.: FOR OFFICE USE ONLY Applicant Movant Processed Y N Y N Scanned Certificate List QC American LegalNet, Inc. www.FormsWorkFlow.com STATE COURT ADMISSIONS: Status (active, inactive) Approx. Date Admitted (if available) 1. 2. 3. FEDERAL COURT ADMISSIONS: Status (active, inactive) Approx. Date Admitted (if available) 1. 2. 3. DISCIPLINARY ACTIONS: Have you ever been disciplined, or are you the subject of any pending disciplinary proceeding, by the bar of any jurisdiction or by any court? [ ] Yes [ ] No If yes, please explain in detail on a separate sheet of paper. CRIMINAL CONVICTIONS: Have you ever been convicted of a criminal offense (other than a traffic offense)? [ ] Yes [ ] No If yes, please explain in detail on a separate sheet of paper. OATH I, , certify that, to the best of my knowledge and belief, the information on this application is true, correct, complete, and made in good faith. I do solemnly swear (or affirm) that I will conduct myself as an attorney and counselor of this court, uprightly and according to law; and that I will support the Constitution of the United States. (original signature) Subscribed and sworn to before me this Notary commission expires: day of , 20 (date) (signature and title) (AFFIX SEAL) MOTION FOR ADMISSION I, , a member of the Bar of the United States Court of Appeals for the Fourth Circuit, hereby move the admission of the applicant to the Bar of the Court. I am satisfied that the applicant is of good moral and professional character and is admitted to practice before the highest court of a state. (date) (original signature) American LegalNet, Inc. www.FormsWorkFlow.com