U.S. District Court Oregon Application for Temporary Special Admission for Government Attorneys [Rev. 03/2018] Page 1 of 3 UNITED STATES DISTRICT COURT DISTRICT OF OREGON In the Matter of the Application of Government Attorney (full name of applicant) ( name of applicant as it will appear on filings) for Special Temporary Admission to the Bar of the United States District Court for the District of Oregon Application for Special Temporary Admission and CM/ECF Registration In accordance with LR 83-4, I am applying for special temporary admission to the Bar of the United States District Court for the District of Oregon. In support of this application, I certify that: 1) I am an active member in good standing with the State Bar; and 2) that I have read and am familiar with the Federal Rules of Evidence, the Federal Rules of Civil and Criminal Procedure, the Local Rules of this Court, and this Court's Statement of Professionalism. I understand that I am required to notify the Court if I leave government service and that my admission to the Bar of the United States District Court for the District of Oregon will be terminated upon my departure from government service. (1) PERSONAL DATA: Name: (Last Name) (First Name) (MI) (Suffix) Agency affiliation: Mailing address: City: State: Zip: Phone number: Fax number: Business e-mail address: American LegalNet, Inc. www.FormsWorkFlow.com U.S. District Court Oregon Application for Temporary Special Admission for Government Attorneys [Rev. 03/2018] Page 2 of 3 (2) EDUCATION: (a) Undergraduate School: City: State: Year Graduated: Degree(s):(b) Graduate School: City: State: Year Graduated: Degree(s): (c) Law School: City: State: Year Graduated: Degree(s): (3) BAR ADMISSION INFORMATION: (a) Date admitted to the Oregon State Bar and bar number: (b) List any other state bar admission(s), date(s) of admission, and bar number(s): (c) Other federal court admission(s) and date(s) of admission: (4) CERTIFICATION OF DISCIPLINARY ACTIONS: I am not now, nor have I ever been subject to any disciplinary action by the Oregon State Bar or any other bar association of which I am a member. I am now or have been subject to disciplinary action by a state or federal bar association. (See attached letter of explanation). I have been reinstated to the Oregon State Bar or other bar association of which I am a member. (Attach a copy of the reinstatement application submitted pursuant to Title 8 of the Oregon State Bar's Rules of Procedure, a copy of the final American LegalNet, Inc. www.FormsWorkFlow.com U.S. District Court Oregon Application for Temporary Special Admission for Government Attorneys [Rev. 03/2018] Page 3 of 3 reinstatement order, if available, or copies of reinstatement documents under other state bar rules.) (5) CM/ECF REGISTRATION: I acknowledge that I will become a registered user of the Court's case management and electronic case filing system (CM/ECF) upon approval of this application, and I consent to electronic service pursuant to Fed. R. Civ. P. 5(b)(2)(E) and the Local Rules of the District of Oregon. DATED: . (Signature) American LegalNet, Inc. www.FormsWorkFlow.com