APPLICATION FOR APPOINTED COUNSEL PROGRAM MONTGOMERY COUNTY, OHIO COMMON PLEAS COURT NAME: FIRM NAME AND ADDRESS: ATTORNEY REGISTRATION NUMBER: TELEPHONE NUMBER(S): FAX NUMBER: EMAIL ADDRESS: LAW SCHOOL ATTENDED: DATE GRADUATED: DATE ADMITTED TO PRACTICE IN OHIO: NUMBER OF TRIALS AS: LEAD COUNSEL: CO-COUNSEL: DATE ATTENDED ANNUAL DBA CRIMINAL LAW CERTIFICATION SEMINAR: CLE CREDITS ARE CURRENT: YES NO PROVIDE TRANSCRIPTS 6 HOURS OVI CLE COMPLETED: YES NO PROVIDE TRANSCRIPTS CAPITAL CASES: YES NO DATE QUALIFIED: ______/______/______ LEAD COUNSEL CO-COUNSEL APPELLATE APPLICATION STATUS: New Applicant Request for Upgrade Resubmit Due to Rule Change APPOINTED COUNSEL: Felony 4-5 Felony 3 Unclassified (Non-capital-Murder or Rape