We ask that you either: (1) fill out this form on-line and then print it and sign it, or (2) save the .PDF form to your computer and fill it out; then print and sign it. This will produce a completed form, in PDF format, which may be searched and copied. PDF images created by scanning paper documents are graphical images and cannot be scanned for content. Electronic signatures will not be accepted. Once the form is completely filled out, please print it; then sign it and mail it to: Clerk U.S. Court of Appeals for the Seventh Circuit 219 S. Dearborn Street Room 2722 Chicago, IL 60604 American LegalNet, Inc. www.FormsWorkFlow.com FOR CLERK’S OFFICE USE ONLY: Check # ___________ Receipt #____________ UNITED STATES COURT OF APPEALS FOR THE SEVENTH CIRCUIT 219 S. Dearborn Street, Chicago, Illinois 60604 APPLICATION FOR ADMISSION TO PRACTICE To be completed by Clerk’s Office personnel. Date of OUT OF COURT Admission: __________________________________ Date of IN COURT Admission: ___________________________ Admitting panel: __________________________________ Applicant Information (Please type or print neatly.) APPLICANT’S NAME: __________________________________________________________________________________ SOCIAL SECURITY NUMBER: ___________________________________________________________________________ NAME OF FIRM OR AGENCY: ___________________________________________________________________________ BUSINESS ADDRESS (physical location/mailbox): ____________________________________________________________ ______________________________________________________________________________________________________ E - MAIL ADDRESS: ___________________________________________________________________________________ BUSINESS TELEPHONE NUMBER: ___________________________________ FAX: ______________________________ DATE FIRST ADMITTED (TO ANY BAR): _________________________________________________________________ STATE(S) IN WHICH APPLICANT IS ADMITTED TO PRACTICE: _____________________________________________ ______________________________________________________________________________________________________ HAVE YOU EVER RECEIVED ANY FORM OF DISCIPLINE (INCLUDING A PRIVATE REPRIMAND OR A SANCTION) FROM A COURT OR A LAWYERS DISCIPLINARY AUTHORITY SINCE YOU WERE FIRST ADMITTED TO PRACTICE LAW? __________________________________________________________________________________ IF THE ANSWER IS OTHER THAN NO, PLEASE STATE ON AN ATTACHED SHEET WHAT HAPPENED AND INCLUDE A COPY OF EACH RELEVANT ORDER. Fee Information The payment of the $150.00 admission fee due under 28 U.S.C. § 1913 and the $15.00 local fee due under Circuit Rule 46 should be made with a single check in the amount of $165.00. Checks should be made payable to the “Clerk, United States Court”. Fee Enclosed OR Fee Waived: Appointed counsel in this court Attorney employed by federal government I hereby certify that the above information is correct and complete. Further, I hereby certify that I have read the “STANDARDS FOR PROFESSIONAL CONDUCT WITHIN THE SEVENTH FEDERAL JUDICIAL CIRCUIT” and agree to conduct myself in accordance therewith. Finally, I 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. ______________________________________________________________ (Signature of Applicant) ______________________________________________________________________________________________________________ Sponsor Information SPONSOR’S NAME: _____________________________________________________________________________________ SPONSOR’S ADDRESS: __________________________________________________________________________________ WHEN ADMITTED TO PRACTICE: ________________________________________________________________________ WHEN ADMITTED TO THIS COURT: ________________________________________________________________________ I hereby vouch for the personal integrity and professional ethics of the applicant and respectfully move that said applicant be admitted as an attorney and counselor of this court. ______________________________________________________________ (Signature of Sponsor) Reproduction of this form is authorized. (March 2005) American LegalNet, Inc. www.FormsWorkFlow.com