United States District Court Northern District of Ohio Sandy Opacich Clerk of Court Office of the Clerk 2-161 Carl B. Stokes United States Court House 801 West Superior Avenue Cleveland, Ohio 44113-1830 (216) 357-7000 Dear Attorney: Thank you for your interest in applying to practice before the United States District Court for the Northern District of Ohio. Enclosed please find the Application for Admission to Practice. Attorneys who find it necessary to appear prior to being admitted to the Bar of this Court may file a motion to appear pro hac vice with payment of the pro hac vice admission fee. Please refer to Local Civil Rule 83.5 and Local Criminal Rule 57.5 regarding admission and pro hac vice requirements. The fee for admission to practice before the United States District Court for the Northern District of Ohio is $230.00. Please make your check payable to: Clerk, U.S. District Court. A portion of this fee entitles attorneys to use the United States Courts Library. Please submit your completed application, requisite documentation and fee payment at any court location in the Northern District of Ohio or mail the application to: Attorney Admissions U.S. District Court, Northern District of Ohio Carl B. Stokes United States Court House 801 West Superior Avenue Cleveland, OH 44113-1830 Attorneys who are admitted to practice will automatically be registered for electronic filing and will be sent a CM/ECF user name and password by e-mail. If you have any questions or require further assistance, please call 1-800-355-8498 and ask to speak with an attorney admission clerk. Yours sincerely, s/ Sandy Opacich Sandy Opacich, Clerk of Court 568 John F. Seiberling Federal Building and U.S. Court House 2 South Main Street Akron, OH 44308-1876 (330) 252-6000 114 James M. Ashley & Thomas W. L. Ashley U.S. Court House 1716 Spielbusch Avenue Toledo, OH 43604-5385 (419) 213-5500 337 Thomas D. Lambros Federal Building and U.S. Court House 125 Market Street Youngstown, OH 44503-1787 (330) 884-7400 Revised April 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com United States District Court Northern District of Ohio Application for Admission to Practice (Personal Statement) Full Name Firm Name Address City, State, Zip Telephone Number Email Address (for Electronic Service) Highest State Court Admitted Highest State Court Admission Date Highest State Court Bar Registration Number Have you ever been disbarred or suspended from practice before any court, department, bureau or commission of any State or the United States, or have you received any reprimand from any such court, department, bureau or commission pertaining to your conduct or fitness as a member of the bar? G Yes (attach a separate statement with specific details) G No Fax Number Generation (Sr., Jr., etc.) If you ever changed your name or been known by any other name or surname please note the former name(s) here. If you have ever been a law clerk to a District Judge or Magistrate Judge please list the Judge's name and the applicable dates. Check the method of admission which applies and attach the required documents. G Standard (Attorneys Residing in Ohio or Attorneys Residing Outside of Ohio that Attended the NDOH District Court Practice Seminar) # # # # G Certificate of Good Standing not older than 30 days from Highest State Court Admitted Statement of Sponsors (members of the Northern District of Ohio Bar who are not related to the applicant) Certificate of Attendance from the NDOH District Court Practice Seminar not older than one year $230.00 Check made payable to: Clerk, U.S. District Court Out of State Reciprocity Attorneys residing outside the State of Ohio may be granted reciprocity if they are admitted to the Bar of another U.S. District Court located outside the State of Ohio and have taken a federal district court practice seminar. # # # # # Certificate of Good Standing not older than 30 days from Highest State Court Admitted Certificate of Good Standing not older than 30 days from a U.S. District Court (outside Ohio) Admitted Statement of Sponsors (members of the Northern District of Ohio Bar who are not related to the applicant) Certificate of Attendance at a Federal District Court Practice Seminar (outside Ohio) $230.00 Check made payable to: Clerk, U.S. District Court G Southern District of Ohio Reciprocity An attorney may be granted reciprocity if they have been admitted to practice in the Southern District of Ohio for at least the past two years. # # Certificate of Good Standing not older than 30 days from the Southern District of Ohio $230.00 Check made payable to: Clerk, U.S. District Court G Attorneys Funded from Judiciary Appropriations and Attorneys for the United States # Application only (Personal Statement) American LegalNet, Inc. www.FormsWorkFlow.com Revised December 1, 2016 Certification (All Applicants) I certify that I have read the foregoing questions and that my answers are complete and true to the best of my knowledge. I agree to abide by all Court rules, orders and policies and procedures governing the use of the electronic filing system. I consent to receiving notice of filings pursuant to Fed. R. Civ. P. 5(b) and 77(d) and Fed. R. Crim. P. 49(b)-(d) via the Court's electronic filing system. The combination of user id and password will serve as the signature of the attorney filing the documents. I agree to protect the security of my password and I will immediately notify the Court if I learn that my password has been compromised by an unauthorized user. _____________________________ Signature of Applicant _______________________ Date Oath or Affirmation of Admission (All Applicants) I do solemnly swear (or affirm) that as an attorney of this Court I will conduct myself uprightly, according to the law and the ethical standards of the Code of Professional Responsibility adopted by the Supreme Court of Ohio, so far as they are not inconsistent with Federal Law, and that I will support the Constitution and laws of the United States. _____________________________ Signature of Applicant _______________________ Date Waiver of Attendance at a Northern District of Ohio Federal District Court Practice Seminar (Out of State Reciprocity Only) I certify that I am familiar with the principles of the Civil Justice Reform Act of 1990, case management planning, the Federal Rules of Civil and Criminal Procedure, the local rules of the Northern District of Ohio, in their entirety, with . . specific attention to