COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. CRIMINAL JUSTICE ACT ASSIGNED COUNSEL AND CIVIL PRO BONO APPLICATION FORM : JUDICIAL Plaintiff(s) Western District of W isconsin -against- SUBPOENA : Please complete the following application form. We will use the information provided to : match panel attorneys with cases, taking into account background and experience. Thank you for your interest in serving as a volunteer attorney in this court. : PLEASE RETURN YOUR COMPLETED APPLICATION TO: Defendant(s) : ...................................................... Magistrate Judge Stephen L. Crocker U.S. District Court, W.D . Wisconsin P.O. Box 591 THE PEOPLE OF THE STATE OF NEW YORK Madison, WI 53701 TO (1) NAME:_________________________________________ Date of Birth:______________ GREETINGS: Law firm name: ________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorableaddress: at the Court Office _________________________________________ located at County of in room , on the day of , 20 , at o'clock in noon, and at any recessed _________________________________________ the or adjourned date, to testify and give evidence as a witness in this action on the part of the Office Telephone No.___________________ Fax No.________________ Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a (2) EDUCATION comply. result of your failure to AND BAR MEMBERSHIP Graduated from ______________________________ School of Law one of the Justices of the Witness, Honorable , Court in County, day of , 20 Year Graduated:_______________ ___ Admitted to practice in the Western District of Wisconsin. Date:__________ (Attorney must sign above and type name below) ___ Admitted to practice in the State of Wisconsin courts. Date:__________ ___ Admitted to practice in the 7th Circuit Court of Attorney(s) for Appeals. Date:__________ Please list any other court admissions, including the admission date(s). ______________________________________________________________________________ Office and P.O. Address 1 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : (3) Calendar No. : JUDICIAL SUBPOENA AREAS OF INTEREST Plaintiff(s) Please indicate the types of cases for which you would like to be appointed: -against____ : Criminal : ____ Habeas Corpus : ____ 42 U.S.C. § 1983 (primarilyDefendant(s) rights) prisoner civil : ...................................................... ____ Social Security Appeals Areas of Special Interest:________________________________________________________ THE PEOPLE OF THE STATE OF NEW YORK TO (4) EXPERIENCE Please provide a brief description of your legal experience. GREETINGS: ___________________________________________________________________________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court ___________________________________________________________________________ located at County of in room , on the day of , 20 , at o'clock in the noon, and ___________________________________________________________________________ at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the State briefly the nature of your present practice:_______________________________ Please indicateto comply with this subpoena is punishable as a contempt of court and will make you liable to Your failure by approximate number your trial experience: the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Federal criminal trials:_______ result of your failure to comply. State court Honorable Witness, trials: Felonies_______ Court in County, Misdemeanors_______ day of Federal court pleas and sentences:_______ , one of the Justices of the , 20 State court pleas and sentences:_______ Civil trials: Federal _______ State _______ (Attorney must sign above and type name below) Social Security Appeals:_______ Attorney(s) for Please indicate any areas in which you have special skills or expertise (e.g. computers, accounting, DNA, etc.)_________________________________________________________ ______________________________________________________________________________ Office and P.O. Address 2 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : (5) Calendar No. : JUDICIAL SUBPOENA CRIMINAL JUSTICE ACT INFORMATION Plaintiff(s) Complete this section only if you are interested in accepting appointments in criminal -against: or habeas corpus cases. : Do you have experience working with the Federal Sentencing Guidelines?________ : Have you taken any CLE courses or attended any training sessions which covered the Federal Sentencing Guidelines?________ Defendant(s) : ...................................................... Title of course(s):________________________________________________ Date:____________ ________________________________________________ Date:____________ THE PEOPLE OF THE STATE OF NEW YORK TO Do you believe you know and understand the Federal Sentencing Guidelines well enough to adequately represent federal defendants?_________ Do you have experience working with the federal habeas corpus statutes, 28 U.S.C. §2254 GREETINGS: or § 2255?____________ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at CountyREFERENCES of (6) in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testifyaand give evidence as a witness in this action on thenumber of at least one Please provide as reference the name, address and telephone part of the attorney who practices in the Western District of Wisconsin: Your ________________________________________________ failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Name the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. ________________________________________________ Address Witness, Honorable Court in County, day of , one of the Justices of the , 20 ___________________________ Phone (Attorney must sign above and type name below) (7) ADDITIONAL INFORMATION Attorney(s) for Can you speak any foreign languages?_____ Please specify:_________________________ Are there any types of cases (e.g. drug cases, bank robbery) that you would prefer not to take?_________________________________________________________________________ Office and P.O. Address 3 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. If you are relatively inexperienced, would you be willing to work under the guidance of a mentor?___________ : JUDICIAL SUBPOENA Plaintiff(s) -against: If you are inexperienced, would you be willing to second-chair, without compensation, a more experienced attorney?____________ : If you are an experienced attorney, would you be willing to have an inexperienced attorney : or law student “shadow” you?___________ Defendant(s) : ...................................................... I hereby certify the above information is true and correct. THE PEOPLE OF THE STATE OF NEW YORK TO _______________________________________ Attorney’s signature Date:________________ GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address 4 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com