Pro Bono Civil Panel Questionnaire and Application First Name: Middle Initial: Last Name: Firm Name (if any): Street Address: City: State: Zip: Home Phone: Work Phone: Fax Number: Email Address: Law School: Attorney Bar Number: Date Admitted to Texas Bar: Date Admitted to N.D. Texas: Other federal district and appellate courts admitted to (and dates admitted): Professional memberships and affiliations: Indicate your Civil Trial experience by providing approximate totals in the following categories: Federal Court State Court Jury Trials Bench Trials Court Hearings Depositions American LegalNet, Inc. www.FormsWorkFlow.com Briefly describe your trial experience in both federal and state court (including criminal trial work).Please list the names and phone numbers of two judges and/or attorneys who know of your ability as a trial attorney: Name Telephone Number 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)? Signature DateI HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. Print and Mail Save and Email Pro Bono Civil Panel United States District Court 1100 Commerce, Room 1452 Dallas, TX 75242-1003 txndmlprobono@txnd.uscourts.gov American LegalNet, Inc. www.FormsWorkFlow.com