INTHEUNITEDSTATESDISTRICTCOURT FORTHEEASTERNDISTRICTOFPENNSYLVANIA APPLICATIONFORADMISSION I,THEUNDERSIGNED,herebymakeapplicationtopracticeintheUnitedStatesDistrictCourtfor the Eastern DistrictofPennsylvania,andinsupportofmyapplication,statethatIhavebeenadmittedto practiceintheSupreme CourtofPennsylvaniaon: ____________________________________________________ _____________________________________________________________________ AdmissionDate AttorneyStateBarI.D.# andthatIamatpresentamemberofthebarofsaidcourtingoodstanding,thatIhavereadandfamiliarized myselfwith theEasternDistrictofPennsylvania'sLocalCivilRule83.5,thatIhavesatisfiedtheattorneyadmissionrequirementsof thesaidLocalCivilRule83.5,thatIwilldemeanmyselfasanattorneyofthiscourt,uprightlyandaccordingtolaw,and thatIwillsupportanddefendtheConstitutionoftheUnitedStates. IagreetofurnishtheClerkofCourtwithanychanges tomyinformationlistedbelow. ____________________________________________________ _____________________________________________________________________ Applicant'sName­PleasePrint Applicant'sSignature _____________________________________________________________________ _____________________________________________________________________ OfficeAddress Firm Sworntoandsubscribedbeforemethis dayof__________________________,20______________ _____________________________________________________________________ City/State/Zip _____________________________________________________________________ TelephoneNo. _____________________________________________________________________ _____________________________________________________________________ EmailAddress FaxNo. ____________________________________________________ DeputyClerk MOTIONANDCERTIFICATE THE UNDERSIGNED member of the bar of the United States District Court for the Eastern District of Pennsylvaniaherebymovestheadmissionof ______________________________________________________________________________ PrintName topracticeinsaidcourtandcertifythatIknow(orafterreasonableinquirybelieve)thattheapplicantisa memberof the bar in good standing of the Supreme Court of Pennsylvania and that the applicant's private and professional characterisgood. Admitted:_________________________________,20________ _____________________________________________________________________ Before_______________________________________________,J. _________________________________________________________ DeputyClerk _____________________________________________________________________ Signature Firm Sponsor'sName­PleasePrint _____________________________________________________________________ _____________________________________________________________________ OfficeAddress City/State/Zip _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ FaxNo. TelephoneNo. August2016 _____________________________________________________________________ EmailAddress American LegalNet, Inc. www.FormsWorkFlow.com  Rule83.5AdmissiontoPractice (a) AnyattorneywhoisamemberingoodstandingofthebaroftheSupremeCourtofPennsylvaniamay, byaverified applicationanduponmotionofamemberofthebarofthisCourt,makeapplicationtobe admittedgenerallyasan attorneyoftheCourt.Afeeestablishedbythiscourtshallbeassessedforallsuch admissions.Noadmissionshall beeffectiveuntilsuchtimeasthefeehasbeenpaid. (b) Thepetitionforadmissionshallaver,underoath,allpertinentfacts.TheCourtmayadmitthe petitioneruponsuch petition and motion or may require that the petitioner offer satisfactory evidence of present good moral and professionalcharacter. (c) Uponadmissionthepetitionershalltakeandsubscribetothefollowingoathoraffirmation: "Ido swear(oraffirm) thatIwilldemeanmyselfasanattorneyofthisCourtuprightlyandaccordinglytolaw andthatIwillsupportand defendtheConstitutionoftheUnitedStates." (d) Uponappropriatemotionandthetakingoftheoathprescribedinsubparagraph(c),anyattorney admittedtothe limitedpracticeprovidedbySubchapterCofthePennsylvaniaBarAdmissionRulesmay beadmittedtoasimilar limitedpracticebeforethiscourtastoallcausesinwhichthedefender associationorlegalservicesprogramwith whichthatattorneyisaffiliatedactsascounsel. 1. The right to practice under this rule shall terminate upon termination of admission to practice under SubchapterCofthePennsylvaniaBarAdmissionRules. 2. The roll of attorneys maintained by the Clerk of this Court shall be specially noted to show those admitted undertheprovisionsofthissubparagraph. (e) Anyattorneywhoisamemberingoodstandingofthebarofthehighestcourtofanystate,territory, ortheDistrict ofColumbiamay,withoutbeingadmittedgenerallyasanattorneyofthisCourt,actasan attorneyinthisCourton behalfoftheUnitedStatesGovernmentoranyofitsdepartmentsoragencies. (f) Anattorneyapplyingforfirsttimeadmissiontothebarofthiscourtmustsimultaneouslyinform thecourt ofanypreviouspublicdisciplinebyanyothercourtoftheUnitedStatesortheDistrictofColumbia,orbya courtofanystate,territory,commonwealthorpossessionoftheUnitedStatesandofanyconvictionfora "seriouscrime"asdefinedintheserules*. Petitions for firsttime admission filed by an attorney who has previously been publicly disciplined by another courtorconvicted ofaseriouscrimeshallbefiledwiththeChiefJudgeofthiscourt.Uponreceiptofthepetition, theChiefJudgeshallassignthematterforprompthearingbeforeoneormorejudgesofthiscourtappointedbythe ChiefJudge.Thejudgeorjudgesassignedtothemattershallthereafterscheduleahearingatwhichthepetitioner shall have the burden of demonstrating, by clear and convincing evidence, that the petitioner has the moral qualifications,competencyandlearninginthelawrequiredforadmissiontopracticelawbeforethiscourt,andthat thepetitioner'sadmissionshallnotbedetrimentaltotheintegrityandstandingofthebarortotheadministration ofjustice,orsubversiveofthepublicinterest. Inalltheabovedescribedproceedings,theattorneyapplyingforfirsttimeadmissionshallhavetherighttocounsel. Allsuchpetitionsshallbeaccompaniedbyanadvancecostdepositinanamounttobesetbythe court,fromtimeto time,tocoveranticipatedcostsoftheproceeding. (g) The judge or judges to whom a matter is assigned under Local Rule 83.5(f) shall make a report and recommendationtothecourtafterahearing.Thecourtshalldecidethematter. *RuleIAttorneysConvictedofCrimes. B. Theterm"seriouscrime"shallincludeanyfelonyandanylessercrimeanecessaryelementofwhich,asdetermined bythestatutoryorcommonlawdefinitionofsuch