IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF TEXAS ________________________ DIVISION § _________________________, § Plaintiff § v. __________________________________ Case Number § ________________________, § Defendant APPLICATION AND ORDER FOR ADMISSION PRO HAC VICE I. Applicant is an attorney and a member of the law firm of (or practices under the name of) ___________________________, with offices at ________________________________________________, (Street Address) ___________________________, __________________, _____________, __________________. (City) (State) (Zip Code) (Telephone No.) II. Applicant will sign all pleadings with the name ___________________________________________. III. Applicant has been retained personally or as a member of the above-named firm by (List All Parties Represented) to provide legal representation in connection with the above-styled matter now pending before the United States District Court, for the Northern District of Texas. IV. Applicant is a member in good standing of the bar of the highest court of the state of __________________________________ , where Applicant regularly practices law. Bar license number:____________________ Admission date:______________________________. V. Applicant has also been admitted to practice before the following courts: Court: Admission Date: Active or Inactive: __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ American LegalNet, Inc. www.FormsWorkflow.com VI. Applicant has never involuntarily lost, temporarily or permanently, the right to practice before any court or tribunal, or resigned in lieu of discipline, except as provided below: VII. Applicant has never been subject to grievance proceedings or involuntary removal proceedings— regardless of outcome—while a member of the bar of any state or federal court or tribunal that requires admission to practice, except as provided below: VIII. Applicant has not been charged, arrested, or convicted of a criminal offense or offenses, except as provided below (omit minor traffic offenses): IX. Applicant has filed for pro hac vice admission in the United States District Court for the Northern District of Texas during the past three (3) years in the following matters: Date of Application Case No. And Style ____________________ ____________________ _____________________________________________________________ _____________________________________________________________ (If necessary, attach statement of additional applications.) X. Local counsel of record associated with Applicant in this matter is ____________________________ who has offices at_________________________________________________________________________, (Address) ________________________. (Telephone No.) XI. Check the appropriate box below. For Application in a Civil Case 9 Applicant has read Dondi Properties Corp. v. Commerce Savs. & Loan Ass’n, 121 F.R.D. 284 (N.D. Tex. 1988) (en banc), and the local civil rules of this court and will comply with the standards of practice adopted in Dondi and with the local civil rules. For Application in a Criminal Case 9 Applicant has read and will comply with the local criminal rules of this court. Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com XII. Applicant respectfully requests to be admitted to practice in the United States District Court for the Northern District of Texas for this cause only. SIGNED this __________ day of __________________, 20_______. ________________________________________ Printed Name of Applicant ________________________________________ Signature I hereby certify that I have served a true and correct copy of this document upon each attorney of record and the original upon the clerk of court accompanied by a $25.00 filing fee on this _________ day of _______________________, __________. ________________________________________ Printed Name of Applicant ________________________________________ Signature ORDER The Court, having considered the above Application for Admission Pro Hac Vice, orders that: 9 the application be granted. The Clerk of Court shall deposit the application fee to the account of the Non-Appropriated Fund of this Court. 9 the application be denied. The Clerk of Court shall return the admission fee to the Applicant. _______________________________ _______________________________________________ DATE JUDICIAL OFFICER Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com