Application for Admission to the Bar Page 1 UNITED STATES DISTRICT COURT District of Rhode Island APPLICATION FOR ADMISSION TO THE BAR Applicant Information Full Name: First Middle Last Generation Address: Firm Name or Agency Street Address Apartment/Unit # City State ZIP Code Phone Number: Email : Date of Birth: RI State Bar # : Education Law School: Date of Graduation : Degree : Professional Affiliation Name all courts (including state courts) before which you have been admitted to practice and provide your admission date for each court (please attach a separate sheet if necessary): State or Federal Court Admission Date American LegalNet, Inc. www.FormsWorkFlow.com Application for Admission to the Bar Page 2 Legal Employment Provide your history of legal practice starting with the most recent: Firm City/State Dates of Employment Position Describe your litigation experience in general, and include in particular, your experience trying cases in federal district courts: Good Standing Have you ever been known by any other name or surname? YES NO Have you ever been disbarred or suspended from practice or otherwise disciplined or sanctioned by any court or other body having disciplinary authority over attorneys? YES NO Are there any disciplinary proceedings pending against you at this time? YES NO Excluding traffic violations punishable by fine only, have you ever been convicted of, or entered a plea of no con test to, any crime ? YES NO Are there any criminal charges pending against you at this time? YES NO Is there any other incident in your career having a bearing upon your character or fitness for a dmission to the bar? YES NO If you answer yes to any of the above questions on this page, you must provide a full explanation as an attachment. Have you ever appeared pro hac vice in this Court? YES NO If you answer yes, list the case, date and presiding judge below Case No. Case Name Date Appear ed Presiding Judge Have you read and are you familiar with the Local Rules of this Court? YES NO American LegalNet, Inc. www.FormsWorkFlow.com Application for Admission to the Bar Page 3 Electronic Case Filing Registration I hereby agree to abide by all Court rules, orders, policies and procedures governing the use of the electronic filing system. I agree that the combination of the user log-in name and the password will serve as my signature for purposes of the Federal Rules of Civil and Criminal Procedure. I agree to protect the security of my password and to immediately notify the Clerk222s Office as soon as I learn that my password may have been compromised. I further agree to promptly notify the court if there is a change in my personal data, such as name, e-mail address, firm address, telephone number, etc., and I will update the appropriate data within the ECF system. I agree that all transmissions for electronic case filings of pleadings and documents to the ECF system shall be titled in accordance with the approved civil and criminal event menus of the ECF system. I further agree to file all documents in accordance with the Fed. R. Civ. P. 5.2, Fed. R. Crim. P. 49.1, and LR Gen 102. See: http://www.privacy.uscourts.gov Certification and Signature I hereby move for admission to the United States District Court for the District of Rhode Island pursuant to LR Gen 202. I have read, acknowledge, and agree to observe and be bound by the local rules and orders of this Court, including the Rules of Professional Conduct of the Rhode Island Supreme Court, as adopted by this Court as the standard of conduct for all attorneys appearing before it. I hereby certify that the foregoing is true and correct. I understand my obligation to notify this Court of any changed circumstances that affect my answers to the questions contained within this application. I certify under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. I do solemnly swear [or affirm] that I will conduct myself as an attorney, proctor, and solicitor of this Court, uprightly and according to law; and that I will support and defend the Constitution of the United States. Signature: Date: Submit this completed application form, a check in the amount of $200.00 payable to Clerk, U.S. District Court, and your Certificate(s) of Good Standing from the R.I. Supreme Court and any jurisdiction where you are a member to: Clerk, U.S. District Court One Exchange Terrace Providence, RI 02903 American LegalNet, Inc. www.FormsWorkFlow.com