UNITED STATES DISTRICT COURT THE FOR NORTHERN DISTRICT TEXAS OF DALLAS DIVISION CIVIL R~GHTS VOLUNTEER ATTORNEY PANEL QUESTIONNAIRE APPLICATION AND Please return to: Attn: Pro Bono Civil Rights Panel United States District Court I100 Commerce, Room 1452 Dallas, TX 75242-1003 NAME: (First) (Last) (Middle) TELEPHONE NUMBERS: OFFICE ADDRESS: Office: Firm Name Home: Fax: E-Mail: Law School: Bar Number: Date Admitted to Texas Bar: to N.D. Texas: Date Admitted Other federal district and appellate courts admitted to (and dates admitted): ~~ Professional memberships and affiliations: -1American LegalNet, Inc. www.FormsWorkflow.com Indicate your Civil Trial experience by providing approximate totals in the following categories: Federal Court State Court Jury Trials Bench Trials Court Hearings Depositions Briefly describe your trial experience in both federal and state court (including criminal trial work). Please indicate your experience with civil rights cases by listing the number of cases you have handled in each category below. Number of Cases Nature of Suit Category Voting [441] Employment [442] Housing/Accommodations [443] Welfare [444] Prisoner Civil Rights (General) [550] Prison Conditions [555] Other Civil Rights [440] Please note any other legal experience you believe would be helpful in handling civil rights cases: -2American LegalNet, Inc. www.FormsWorkflow.com Please list the names and phone numbers of two judges and/or attorneys who know of your ability as a trial attorney: Name: Telephone No: How many appointments are you willing to accept per year? Are you fluent in any foreign language(s)? If so, list: Are you willing to take appointments based on your foreign language proficiency? Have you already handled a case through this panel? If so, when? Are you currently working on it? If you have completed work on the case, how was it resolved (jury trial, settlement, etc.)? I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT: Signature Date -3American LegalNet, Inc. www.FormsWorkflow.com