Board of Law Examiners Appointed by the Supreme Court of Texas CERTIFICATION OF JURIS DOCTORATE DEGREE APPLICANT: Complete this portion of the form before submitting to your law school registrar or dean. APPLICANT: SOCIAL SECURITY NO.*: BIRTH DATE: DESIRED BAR EXAM (mm/yy): LAW SCHOOL: DATES ATTENDED: I hereby consent to the release, to the Texas Board of Law Examiners, of the information requested in this form. SIGNATURE: DATE SIGNED: * The provision of your SSN is voluntary, pursuant to Sec. 7, Privacy Act of 1974. If this data is provided, the Board will use it in its investigation and verification, to avoid errors of identity that might introduce problems and delays into the certification and licensure process. The Board appreciates your furnishing this information on a voluntary basis. DEAN OR REGISTRAR: Complete this portion of the form and return it to the Board. ABA-Approved Law School: _____ Yes _____ No Date Approved: ______________________________ I certify that this applicant has: _____ completed all requirements for a J.D., awarded on __________________________ (date); _____ completed ___________ of the ___________ hours required for graduation with a J.D. degree; _____ is enrolled in a joint degree program and has completed __________ of the __________ hours required for graduation with a J.D. degree. Do not return this form until the applicant has been awarded the J.D. degree OR is within 4 semester hours (or the equivalent in quarter hours) of the J.D. degree award. An original, signed copy of this form must be received by the Board at least 4 weeks before the date of the exam stated above to guarantee admission to the exam. Fax copies are not acceptable for purposes of issuing an admission ticket. _____________________________________________________________ SIGNATURE OF DEAN OR REGISTRAR ________________________________________ DATE SIGNED _____________________________________________________________ PRINTED NAME OF DEAN OR REGISTRAR (LAW SCHOOL SEAL) _____________________________________________________________ TELEPHONE NUMBER MAILING ADDRESS Post Office Box 13486 Austin, Texas 78711-3486 Telephone: 512-463-1621 ˜ Facsimile: 512-463-5300 ˜ Website: www.ble.state.tx.us STREET ADDRESS 205 West 14th Street, 5th Floor Austin, Texas 78701 American LegalNet, Inc. www.FormsWorkFlow.com