IN THE UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT OF VIRGINIA ________________ DIVISION APPLICATION TO QUALIFY AS A THIRD YEAR LAW STUDENT PERMITTED TO APPEAR IN THE UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT OF VIRGINIA To: Honorable United States Bankruptcy Judge PERSONAL STATEMENT My full name is _______________________________________________________________________________ My residence address is ________________________________________________________________________ I was born at _________________________________________________________________________________ My father's name is (was) ______________________________________________________________________ My mother's name is (was) _____________________________________________________________________ I am duly enrolled in a law school approved by the American Bar Association or Virginia Board of Examiners. The School in which I am enrolled is: . I have completed legal studies amounting to at least four (4) semesters. I understand that I am neither to ask for nor receive any compensation or remuneration of any kind for my services from the person on whose behalf I render services. I hereby certify that I have read and am familiar with the Virginia Code of Professional Responsibility. I do certify that I have read or reread within ninety days prior to the submission of this application (a) The Federal Rules of Civil Procedure, (b) the Federal Rules of Evidence, (c) the Federal Rules of Bankruptcy Procedure, and (d) the Local Rules of this Court. The member of the bar under whose supervision I shall perform any of the things permitted by Rule 83.1(K) of the Local Rules of Practice of the District Court, as made applicable by LBR 2090-1(K) of the Local Bankruptcy Rules of this Court, . is: Signature Subscribed and sworn to before me this My commission expires: day of . , 20 . Notary Public ------------------------------------------------------------------------------------------------------------------------------------------I CERTIFY that the above applicant is currently enrolled in , a law school initially approved by the American Bar Association on , 20 ,which approval is current; and That the above applicant has completed the equivalent of four semesters of law studies, is of good character, has competent legal ability, and has been trained to perform as a legal intern. Dean Law School College or University ------------------------------------------------------------------------------------------------------------------------------------------I, the undersigned, do certify that I am a member of the bar of this Court, and hereby assume professional responsibility for the applicant's guidance in any work undertaken and for supervising the quality of the applicant's work. Supervising Attorney [thirdyrls ver. R- 01/01/97] American LegalNet, Inc. www.FormsWorkFlow.com