APPLICATION FOR ADMISSION TO PRACTICE IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF TENNESSEE Name ________________________________________________________ BPR#________________ SSN_________________________ Date of Birth _______________________________Place of Birth___________________________________________________________ Place of Employment_______________________________________________________________________________________________ and Office Address ________________________________________________________________________________________________________________ E-mail address:* __________________________________________ Phone: _________________________________________ Schools, colleges, and professional schools attended, length of time spent in each and degrees attained:______________________________ ________________________________________________________________________________________________________________ Place and date of admission to practice in the highest court of a state, territory, or the District of Columbia ________________________________________________________________________________________________________________ Attach a copy of the certificate from the clerk or other duly authorized official evidencing your admission to practice in the highest court of a state, territory or the District of Columbia. I have been admitted to and am entitled to practice in the United States District Court for the ___________________________________ _____________________________________________District of _________________________________________________ Is there any charge pending against you, or have you been convicted in a state or federal court of a crime punishable by imprisonment for more than one year? _________________ If so, state the nature of the offense, the date charged, plea entered, or conviction, and the court in which the charges were filed._________________________________________________________________________________________ ________________________________________________________________________________________________________________ Have you ever been disbarred, suspended, reprimanded, censured, or disciplined by a court of record, other judicial or quasi-judicial tribunal, or a board of disciplinary responsibility or similar body? If so, by what court, tribunal, or disciplinary body? Please provide the date and nature of the disciplinary action._______________________________________________________________________________ ________________________________________________________________________________________ Signature of Applicant Date SPONSORS (Must be admitted to practice in the U.S. District Court for the Eastern District of Tennessee and personally know, but not be related to, the applicant) We hereby endorse the correctness of the applicant's statement. The applicant possesses all of the qualifications required for admission and is of good moral and professional character. 1. __________________________________________________________ Please type or print name ________________________________ Signature ______________ Years Known ______________________________________________________________________________________________________________ Address ___________________________________________________________ E-mail address* ________________________________ Phone ______________ BPR # 2. ____________________________________________________________ ________________________________ Please type or print name Signature ______________ Years Known ______________________________________________________________________________________________________________ Address ___________________________________________________________ E-mail address* ________________________________ Phone ______________ BPR # *E-mail addresses will be used for important correspondence regarding this application. File this application and the $160.00 filing fee at the appropriate divisional office. DO NOT FORGET TO ATTACH THE APPROPRIATE CERTIFICATE OF ADMISSION American LegalNet, Inc. www.FormsWorkflow.com RELEASE I hereby release the Board of Professional Responsibility of the Supreme Court of Tennessee, and the disciplinary agency of any other state in which I have been or am licensed to practice, to provide to the United States District Court for the Eastern District of Tennessee information on all disciplinary complaints ever filed against me, including complaints resulting in non-public discipline and complaints administratively dismissed by the Board or any other disciplinary agency described above. Applicant’s signature:___________________________Date:____________ American LegalNet, Inc. www.FormsWorkflow.com