UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF TEXAS SAN ANTONIO DIVISION CRIMINAL JUSTICE ACT (CJA) PANEL QUESTIONNAIRE AND APPLICATION Please return to: Attn: CJA Panel Committee c/o Wendy Branham, Judicial Assistant 655 E. César E. Chávez Boulevard San Antonio, Texas 78206-1100 1. Name: Office Address: Telephone Numbers: Office: Cell: Fax: SSN or TIN: Texas Bar Number, and date admitted: Date Admitted to Western District of Texas: Other jurisdiction(s) admitted to practice law, and date(s) of admission(s): E-mail: Law school, and date of degree: Professional affiliations: 2. Please select the panel category, or categories, you would like to be considered for: General Felony Complex-Case Appellate Non-Capital Habeas Auxiliary Material Witness GYes GYes GYes GYes GYes GYes GNo GNo GNo GNo GNo GNo American LegalNet, Inc. www.FormsWorkFlow.com 3. Indicate your relevant court experience by providing approximate totals in the following categories: Criminal Jury Trials: Federal Felony: State Felony: Criminal Bench Trials: Federal Felony: State Felony: Pleas and Sentences: Federal Felony: State Felony: Criminal Appeals: Federal Felony: State Felony: Appellate Oral Arguments: Federal Court: Federal Misdemeanor: State Misdemeanor: Federal Misdemeanor: State Misdemeanor: Federal Misdemeanor: State Misdemeanor: Federal Misdemeanor: State Misdemeanor: State Court: State Court: State Court: Habeas/28 U.S.C. §2255 Hearings: Federal Court: Other Relevant Court Hearings: Federal Court: If you indicated any relevant court hearings, please briefly describe: 4. Indicate any other legal experience which qualifies you for membership on the panel(s) for which you have applied (for example, experience in a prosecutor's or public defender's office, service as a judicial law clerk, or areas in which you have received Texas Board of Legal Specialization Certification): 5. List the names and phones numbers of three lawyers who know of your ability as a criminal law attorney: Name: Phone Number: 6. Have you ever been subject to, or are you currently the subject of a pending action for, any of the following: disbarment, suspension, public reprimand, contempt, disciplinary action or complaint by any state or federal court, or other disciplinary action by or before any bar association and/or licensing agency? GYes GNo If you answered yes, please describe the underlying circumstances in detail (see question 8). American LegalNet, Inc. www.FormsWorkFlow.com 7. Are you fluent in any language other than English, so that you can personally communicate with a client who speaks only that language without the assistance of any other person, including office staff, a hired investigator, or any other interpreter? If so, please list language(s): 8. Please provide any additional information you believe the Committee should consider. (You may use this space to provide additional information concerning any of your answers above.) GYes GNo I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT: SIGNATURE DATE Optional: Please attach a current picture to your application. American LegalNet, Inc. www.FormsWorkFlow.com