Application Attorney Examination Application July 2017 Utah State Bar Office of Admissions 645 South 200 East Salt Lake City, Utah 84111-3834 [email protected]
INSTRUCTIONS AND INFORMATION
The practice of law is a privilege, not a right. An Applicant has the burden of proving by clear and convincing evidence that he or she has the character and fitness to practice law in Utah. The first step in meeting this burden is to complete and file the application and all associated materials in a careful and timely manner. An Applicant's cooperation, comprehensiveness, and candor in the application process reflects on the likelihood that the Applicant will truthfully deal with courts and opposing parties, the Applicant's attitude toward authority, and whether the Applicant will follow rules, laws, and standards once a licensed lawyer.
Instructions are provided in italics throughout the Application. More detailed instructions and information on the application process can be found in a Word document on the Admissions Website. You should read the Word document before you complete this application. As you complete the application be sure to read all instructions and each question carefully.
This application conforms with the requirements outlined in the Rules Governing Admission to the Utah State Bar ("Rules"). You should refer to these Rules (available on the Admissions Website at http://www.utahbar.org/admissions/rules-governing-bar-admissions/) prior to completing the application.
Neither the Bar nor its representatives has the authority to waive the deadlines, fees, or requirements contained in the Rules.
COMPLETING AND FILING THE APPLICATION
You will complete and file this Application online. In addition, you will need to complete or obtain other documents which will be uploaded using your Synergy account.
A s you answer certain questions you will see instructions to complete a particular form or upload a supporting document. These instructions are underlined in blue (these are not hyperlinks). Make note of those that apply to you as you go. This will help you gather the necessary documentation once the online application is submitted.
Absolute and complete candor is required. Omissions or misstatements in the application are presumed intentional. Failure to be completely candid in your application will result in denial of admission, or discipline if you have already been admitted.
All questions must be fully answered. If a particular question does not apply or the answer is 'none' or 'not applicable', so state. If you are uncertain whether your situation falls within the scope of a particular question, assume that it does.
If the question calls for an explanation, provide a detailed narrative of all the circumstances and events leading up to and surrounding the incident(s) described in your response. Do not simply refer the Committee to read the attached documentation you provide (for example, a police report or pleading); it is your opportunity to explain the situation in your own words.
NOTE: DO NOT USE THE 'LESS THAN' SYMBOL WHEN COMPLETING THIS APPLICATION. IT CAUSES AN ERROR. For Reference Only DO NOT fill out this form for submission to the Bar. It is posted merely to give you an overview of what questions to expect when you fill out the online application form through your Synergy account.
This is a sample of an attorney examination application. If you are a different applicant type, there may be some variations when you go to fill out your application, so make sure you read the instructions and questions carefully as you fill out the online form. UTAH STATE BAR ATTORNEY APPLICATION FOR ADMISSION BY EXAMINATION
Type your First and Last Name:
By completing this application you are applying to sit for the July 2017 Bar Examination. The deadline to submit the application with all required supplemental documentation is March 1st. After March 1st, a $100 late fee is required. After March 15th, a $300 late fee will be assessed. NO applications will be accepted after April 3rd, the final deadline.
In order to meet the deadline you must submit all documents in the appropriate format. Refer to the Attorney Examination Checklist for guidance on what is required for your application to be considered complete. All required documents must be received no later than the close of business on the appropriate filing deadline--NOT postmarked.
The essay portion of the examination may be completed using a laptop computer or by handwriting. If you intend to complete your MEE/MPT answers on your laptop, you must pay a non-refundable $150 computer registration fee. The fee covers the software license, technical support, the site technician, power, and administrative costs. You will NOT be entitled to a refund in the event you experience technical difficulties using the exam software, fail to attend the Bar exam, withdraw your application, or are disqualified for any reason. You will receive information in early June about registering and downloading the necessary software.
EXAMINATION ESSAY ACCOMMODATIONS. I wish to complete the written portion by:
Computer * Writing
* Your request will not be processed until you submit the signed Laptop Acknowledgment form .
If you have a condition which necessitates the use of medically-prescribed devices or aids (medication, lactation pump, inhaler, neck brace, wheelchair, crutches, etc.) you will need to complete the Courtesy Provisions for Health-Related Conditions form and attach a doctor's note .
If you are temporarily or permanently disabled and require accommodations affecting the format or administration of the exam, you must request test accommodations using Forms J through O. The instructions and forms for making the request are found on the Admissions website. Test Accommodation documentation is subject to the same filing deadlines and late fees as the Application.
TESTING ACCOMMODATIONS . I have a DISABILITY for which I am requesting special test accommodations.
Yes * No
* Your test accommodation request will not be reviewed or granted if you fail to file the required forms and medical documentation . See General Guidelines for Test Accommodations for specific details.
There is only one test location for the Bar Exam.
Test location: SandySandy 1. Provide your full name as you would like it to appear on Utah State Bar records:
First Name: Middle Name or Initial: Last Name:
2. Have you taken the MPRE? Yes No
If yes, please provide: Date of MPRE Exam (mm/yyyy): Scaled Score:
If no, indicate the date of the exam you have registered Date scheduled to take MPRE Exam: to take:
If you have taken the MPRE and received a passing score, you must arrange to have official notice of your MPRE score sent directly to the Admissions Office from the National Conference of Bar Examiners (NCBE) . If you have not taken the MPRE, you should register with the NCBE for the next scheduled administration. If you do not have record of your score on hand when completing the Application, type "See Score Report" in the Scaled Score box.
There is no time limit on an MPRE score. However, if you are unable to provide proof of a passing score either from the NCBE or from another jurisdiction (applies to scores earned before 1999), you must retake the exam.
3. Provide the name of the law school where you received your J.D.
Name of Law School:
Indicate the month and year you graduated:
You must provide a copy of the Certificate of Law School Graduation form to your law school Dean or Registrar for completion, and ensure that the Bar receives the completed Certificate of Law School Graduation by close of business on the filing deadline. The Certificate may be mailed by the school directly to the Bar or it may be mailed to you so you can forward it to the Bar.
Was your law school approved by the American Bar Association when you received your law degree?
If you have not graduated from an ABA-approved law school, you are not eligible to apply for admission to the Utah State Bar Yes No unless you meet the qualifications for an exception, found in Rule 14-704(b).
4. Prior to this application; have you ever filed an application for admission to practice law in Utah? Yes No
If YES, indicate Date (approx.) of application(s): Date of application(s): GENERAL
5. NCBE Number:
Applicants must have an NCBE Number. This number is assigned by the National Conference of Bar Examiners for identification purposes. To obtain an NCBE number, please go to www.ncbex.org/ncbe-number .
6. Mailing address:
The Bar will use this address for any correspondence that may be sent through the mail. Please verify that it is accurate and that there are no typographical errors.
Address1:
Address2:
City: ST: ZIP:
7. Email address: [email protected]
Most correspondence will take place via email. You should list an email that you check frequently. Although school emails are acceptable, it is not uncommon for applicants to stop using this email after graduation or for the school to close the email. Therefore, if you choose to list a school email address, it is your responsibility to update the Bar with a new address should one of the above occur. There will be no special consideration for applicants who fail to check or update their email address and miss crucial correspondence.
8. Home telephone number: -- Cell number:
9. Gender Male Female
10. Drivers License Information:
(a) Current License: ST: -- License No.:
(b) Previous state(s) where you have held a license in the last three years:
(c) Have you every had a driver's license suspended or revoked? Yes No
Explanation:
You must provide driving record(s) covering three years. If you have held a license in more than one state within the last three years, this means you must request a record from each of those states. 11. Date of Birth (mm/dd/yyyy): Age:
12. Birth place: City: ST: Country:
13. Are you a citizen of the United States? Yes No
(a) If no, what is your country of citizenship and your immigration status? Please submit copies of relevant documents verifying that you are currently in the U.S. legally.
(b) If yes, and if you were born outside of the United States, please provide proof of citizenship.
14. Have you ever been known by any other name or surname? If yes, please disclose all names used and provide an explanation for each change. If a married woman, give a maiden name. Yes No
Explanation:
Name(s):
15. Names of parents including middle and maiden names:
Parent:
Parent:
16. Are you currently married? Yes No
If yes, give the date and place of marriage and full name of spouse.
Full name:
Date of marriage:
Place of Marriage (City and State or Country):
Spouse's current address: Same as mine
Address:
City: ST: ZIP:
17. Have you ever been or are you in the process of being divorced? If yes, please complete FORM E . Yes No
If yes, provide the following information for each former spouse:
Full name: Date of marriage (mm/dd/yyyy):
Date divorce finalized (mm/dd/yyyy):
Place of Marriage (City and State or Country):
Current address and email:
Address:
City: ST: ZIP:
Email address:
Additional Divorces:
18. Are you the obligor on any spousal and/or child support? Yes No
If yes, are you current on all spousal and/or child support payments? Yes No
If yes, provide a record of your support payment history.
If no, complete FORM B and submit a record of your support payment history .
Acceptable records of your support payment history include an official court record, a notarized affidavit from the former spouse, or copies of cancelled checks. The record must cover at least the six months preceding the application.
An Applicant who is not current on support payments WILL NOT be approved.. RESIDENCE HISTORY
19. List every permanent and temporary residence at which you have lived during the last 10 years. Beginning with your current address, list addresses in reverse chronological order.
This question is more interested in your physical location than in where you were receiving mail. There are only three exceptions to this: (1) If you served an LDS mission, you may list the address of the mission home; (2) If you studied abroad you may list the school's address; and (3) If you spent a considerable amount of time traveling, you may list the country (countries) where you were traveling without including the street addresses of the hotels where you stayed.
If you had two residences at one time, please explain the situation under "Additional Addresses". This space should also be used if you have to list more than nine addresses.
Current Address, From Mo/YY:
Street:
City: St: Zip:
From Mo/YY: To Mo/YY:
Street:
City: ST: Zip:
From Mo/YY: To Mo/YY:
Street:
City: ST: Zip:
From Mo/YY: To Mo/YY:
Street:
City: ST: Zip:
From Mo/YY: To Mo/YY:
Street:
City: ST: Zip:
From Mo/YY: To Mo/YY:
Street:
City: St: Zip:
From Mo/YY: To Mo/YY:
Street:
City: ST: Zip:
From Mo/YY: To Mo/YY: Street:
City: ST: Zip:
From Mo/YY: To Mo/YY:
Street:
City: ST: Zip:
Additional Addresses: EDUCATION
20. List the names of all the colleges and universities you have attended, other than law schools. Provide the address, the dates attended, and the degree received. Type “ND” if you did not receive a degree. List in reverse chronological order starting with most recent.
You only need to list colleges and universities which you attended AFTER graduating from high school.
Name:
Address:
City: ST: Zip:
Date attended from: Date attended to: Degree:
Name:
Address:
City: ST: Zip:
Date attended from: Date attended to: Degree:
Name:
Address:
City: ST: Zip:
Date attended from: Date attended to: Degree:
21. List below the names of all the law schools you have attended. Provide the dates attended, the degree received or expected, and the address. Write “ND” if you did not receive a degree. List schools in reverse chronological order starting with most recent:
Law School currently attending/attended:
Date attended from: Date attended to: Degree:
School Address:
City: ST: ZIP:
Law School currently attending/attended:
Date attended from: Date attended to: Degree:
School Address:
City: ST: ZIP: 22. Has a report or charge of misconduct or irregularity ever been issued against you by the Law School Admission Council in connection with the admission process to law school? The admission process includes, but is not limited to, application for admission Yes No to law school, application to take the LSAT, and sitting for the LSAT.
If yes, please provide a full explanation. You must submit all documentation related to the incident(s) .
Date of occurrence(s) (mm/dd/yyyy):
Explanation:
23(a). Have you ever been investigated for a violation of any policy (academic or non-academic) at a college, university or law school, whether or not any action was taken against you or whether or not the school agreed not to disclose the Yes No incident on your permanent record? Include pending matters.
If yes, please provide a full explanation. If this occurred within the last 10 years you must submit all documentation related to the investigation , both from your own files and from the school.
Name of institution:
Date of occurrence(s) (mm/dd/yyyy):
Explanation:
23(b). Have you ever been dropped, suspended, warned, sanctioned, placed on scholastic or disciplinary probation, expelled or requested to resign or allowed to resign in lieu of discipline, been advised to discontinue your studies, or otherwise had disciplinary Yes No action of any sort taken against you (academic or non-academic) by a college, university or law school?
If yes, please provide a full explanation. If this occurred within the last 10 years you must submit all documentation related to the incident both from your own files and from the school.
Name of institution:
Date of occurrence(s) (mm/dd/yyyy):
Explanation:
EMPLOYMENT HISTORY
24. List every permanent and temporary job you have held (1) since you were eighteen years of age or (2) in the last ten years (whichever is shortest).
If an employer is no longer in business, provide the address as it was when you were employed there; instead of a phone number, include a note that it no longer exists. If you cannot recall the name of your supervisor or any co-workers, so state. List all legal internships, paid or unpaid. List other internships only if you were paid. If you list an internship as your current employment, remember to amend your application when this employment ends. Include self-employment, such as business ownership or solo practice. For 'Reason for Leaving' do not write a variant of "started a new job"--you must explain your reason for seeking new employment.
Current Employment
Date Start: Position:
Name of Employer:
Supervisor First Name: Last Name:
Co-Worker First Name: Last Name:
Address:
City: ST: Zip:
Phone: Fax: Supervisor Email:
Date Start: Date End: Position:
Name of Employer:
Supervisor First Name: Last Name:
Co-Worker First Name: Last Name:
Address:
City: ST: Zip:
Phone: Fax: Supervisor Email:
Reason for leaving:
Date Start: Date End: Position:
Name of Employer:
Supervisor First Name: Last Name:
Co-Worker First Name: Last Name:
Address:
City: ST: Zip: Phone: Fax: Supervisor Email:
Reason for leaving:
Date Start: Date End: Position:
Name of Employer:
Supervisor First Name: Last Name:
Address:
City: ST: Zip:
Phone: Fax: Supervisor Email:
Reason for leaving:
Date Start: Date End: Position:
Name of Employer:
Supervisor First Name: Last Name:
Address:
City: ST: Zip:
Phone: Fax: Supervisor Email:
Reason for leaving:
Date Start: Date End: Position:
Name of Employer:
Supervisor First Name: Last Name:
Address:
City: ST: Zip:
Phone: Fax: Supervisor Email: Reason for leaving:
If you have additional employment history, please enter that information here, providing the same information as with previously listed employment.
If you are or were self-employed at any time or if you have ever owned a business, provide a brief explanation of the nature of the business as well as a reference who can verify the nature and length of your employment or practice:
Explanation:
Reference first name: Last name:
Address:
City: ST: ZIP:
Contact information: 25. Account for any period of time when you were unemployed for more than four months (e.g. full-time student, studying for the Bar examination, seeking employment, volunteering, etc.).
This question should NOT be left blank unless you have never been out of work for more than three months at a time in the last ten years.
26(a). Have you ever been confronted by an employer, supervisor, or colleague concerning excessive absences or lateness, lack of diligence, failure to maintain confidential material or employment-related misconduct or deficiency? Yes No
If yes, provide the following information about each occurrence:
Employer:
Date of employment - From: To:
Explanation:
26(b). Have you ever been laid-off, terminated, suspended, disciplined, permitted to resign in lieu of termination, or otherwise discharged from any job? Yes No
If yes, provide the following information about each occurrence:
Employer:
Date of employment - From: To:
Explanation:
Additional terminations or employment discipline:
27. Have you ever applied for or held a license for a business, trade, or profession, other than as an attorney-at-law (even if the application was subsequently withdrawn)? Yes No
If yes, provide the following information about each license:
Type of license:
From: To:
License Number: Current status of license:
Issuing Authority:
Address:
City: ST: Zip:
Telephone Number:
Type of license:
From: To:
License Number: Current status of license:
Issuing Authority:
Address:
City: ST: Zip:
Telephone Number:
Additional licenses:
28. Has any business that you had a financial interest in, managed, or actively participated in the control of been investigated or charged, formally or informally, with fraud, larceny, embezzlement, misrepresentation, conspiracy to conceal, or a similar offense? Yes No
Explanation:
29. Have you ever been denied a license for a business, trade, or profession (e.g., CPA, real estate broker, physician, patent practitioner) or had a business, trade or professional license revoked? Yes No 30. Have you ever been disciplined by a professional licensing or regulatory agency? Yes No
31. If you answered yes to either Question 29 or 30, please provide the following information and submit all documentation relevant to the denial, revocation or discipline :
Name of regulatory agency:
Address:
City: ST: Zip:
Telephone number:
Agency Action:
Date:
Explanation:
Additional license discipline or denial:
MILITARY SERVICE
32. Have you ever been a member of the armed forces of the United States, its reserve components or the National Guard? If yes, complete Form A . Yes No FINANCIAL HISTORY
You should obtain a personal credit report before completing these questions to ensure that your responses are accurate.
Applicants who are past due, have accounts in collections or charged-off, or have unpaid taxes, liens, or judgments will NOT be approved.
33. Have you ever had a judgment against you? If yes, please complete Form B . Yes No
34. In the last ten years, have you had an account or a bill charged off, sent to collections, or settled for less than the full balance? If yes, please complete Form B . Yes No
35. In the last two years, have you been more than 60 days late on any payment to a creditor, including the holder of student loans? If yes, please complete Form B . Yes No
36. In the last ten years have you had a credit card or charge account revoked or closed for nonpayment? If yes, please complete Form B . Yes No
37. Have you ever been adjudicated a bankrupt, or has a petition for bankruptcy been filed at any time by you or against you, either alone or in association with others, either personally or in a business capacity? If yes, please complete Form C . Yes No
38. Have you ever been brought in as a party to any proceedings in a bankruptcy court; or have you ever been sued or threatened with suit by the receiver, trustee, or other authority of any bankrupt estate, for unlawful preference, conspiracy to conceal assets, or Yes No any other fraud or offense, whether punishable by criminal law or not? If yes, please complete Form C .
39. Has an adversary proceeding ever been filed against you to except a scheduled debt from discharge? If yes, please complete Form E . Yes No
40. Have any state or federal tax liens ever been placed against your personal or business property? If yes, please complete Form D . Yes No
41. Have you ever failed to file a personal income or business tax return, filed late without an extension, or failed to pay your taxes when due? If yes, please list each occurrence and provide an explanation of your reasons. Yes No
Explanation:
42. Have you or your business or corporation or other entity in which you hold or held more than 20% equity interest or for which you served as an executive officer ever failed to pay employer’s withholding taxes or failed to remit sales or excise taxes paid by Yes No customers? If yes, please complete Form D.
CIVIL ACTIONS
43. Have you, in any capacity, ever been a party to or named or described in any civil proceeding, action, suit, arbitration, or administrative proceeding, including family law cases such as divorce or child support matters? Include suits against businesses or Yes No law firms of which you are an owner, partner, or fiduciary. If yes, please complete Form E .
44. Have you ever been found in contempt by any court, tribunal, or legislative body? If yes, provide a complete explanation below and upload copies of any records related to the incident(s) . Yes No
Explanation: 45. Have you ever failed to comply with any court order directed against you, including child support or other family law orders? If yes, provide a complete explanation below, and upload copies of any records related to the incident(s) . Yes No
Explanation: CRIMINAL HISTORY
46. As an adult or a juvenile, have you ever been arrested, served with a summons, cited, indicted, charged, tried, or investigated for an infraction, felony or misdemeanor in any jurisdiction? Include all such incidents no matter how minor, whether guilty or not. Please include all matters that have been expunged or subject to a diversionary program. Do not include traffic violations, as these Yes No are addressed in the next question. If yes, please complete Form F .
47. Within the last ten years have you ever been cited for a traffic violation, moving or non-moving, other than parking offenses? Include all such incidents, no matter how minor, whether guilty or not, and regardless of whether they were dismissed or subject to a diversionary program. If yes, complete Form G. Yes No The DMV record is not a reliable source for answering this question or completing the necessary form(s). Such records only show the most recent offenses, and then only those offenses which the Courts reported to the DMV. In completing the requirements for this question, you should access the court database of the applicable state to find information on past traffic violations.
48. Are you in violation of any federal or state criminal statute? Yes No
Explanation:
49. Have you ever been charged, accused, or indicted, formally or informally, civilly or criminally, for misrepresentation, fraud, misapplication, perjury/false swearing, or misappropriation of property, either individually or in a representative capacity (e.g., as an officer or owner of a business entity, partner or other fiduciary relationship)? If yes, please complete Form E or Form F , whichever Yes No is applicable
PROFESSIONAL HISTORY
50. Have you ever been suspended, censured, or otherwise reprimanded or disqualified as a member of another profession, or as a holder of public office? If yes, please provide a complete explanation. Yes No
Explanation:
51. Have there ever been or are there now any formal or informal charges, complaints, or grievances concerning your conduct as a member of any other profession, or as a holder of public office? If yes, please provide a complete explanation. Yes No
Explanation:
52. Has any surety bond on which you were the principal been required to pay any money on your behalf? If yes, please provide a complete explanation. Yes No Explanation:
PRACTICE OF LAW IN UTAH
53. Have you ever given legal advice and/or held yourself out as an attorney, lawyer, or legal counselor while in the state of Utah? If yes, please provide a complete explanation.
If you have acted as an attorney in the state of Utah, lawfully or otherwise, you must answer 'Yes'. If you are currently working for a law Yes No firm in Utah and are listed on the website, business cards, or letterhead as an 'Associate' or 'Partner', you must answer 'Yes'. If you have ever been admitted Pro Hac Vice in this state, you must answer 'Yes'.
Explanation:
54. Have you ever engaged in the unauthorized practice of law in the state of Utah, or has such a complaint ever been filed against you? If yes, please provide a complete explanation.
If you are not admitted to the Utah State Bar, you cannot practice law in the state of Utah. The only exceptions are if a specific federal law Yes No expressly permits a person to practice without being licensed in this state (e.g. Patent Attorneys), or if you are working as House Counsel and have an application pending before the Bar. Applicants to the Bar must be especially careful not to give legal advice or otherwise practice law while their application is pending . PRIOR APPLICATION FOR BAR ADMISSION
Applicants who have been denied admission to any other Bar must wait the length of time specified for reapplying to that jurisdiction before applying for admission in Utah.
55. List every jurisdiction to which you have ever submitted an application to sit for the examination or to be admitted, whether by examination, UBE transfer, motion, diploma privilege, or reinstatement. Include applications to register before the USPTO as a patent attorney; exclude applications to federal district courts. Provide a brief narrative explanation of the circumstances for any withdrawals of applications or failures to be admitted.
State, province or foreign country:
Applied for admission by: UBE Transfer Bar Exam Motion Diploma Reinstatement
Dates of all applications made (MM/YY):
Dates of all examinations taken (MM/YY):
Admitted or readmitted (MM/DD/YY):
If admitted, attorney Bar number:
Were you asked to appear for an interview or hearing?: Yes No (If yes, please explain below.)
Not admitted due to: (Explain below) Failed exam Withdrew application Pending Denial
Explanation for interview, withdrawal or denial:
State, province or foreign country:
Applied for admission by: UBE Transfer Bar exam Motion Diploma Reinstatement
Dates of all applications made (MM/YY):
Dates of all examinations taken (MM/YY):
Admitted or readmitted (MM/DD/YY):
If admitted, attorney Bar number:
Were you asked to appear for an interview or hearing?: Yes No (If yes, please explain below.)
Not admitted due to: (Explain below) Failed exam Withdrew application Pending Denial
Explanation for interview, withdrawal or denial:
Additional applications/admissions:
56. Have you ever held any judicial office? If yes, please provide the following information. Yes No
When:
Where:
What office/position held:
If terminated, why?
Additonal judicial offices: OTHER CONDUCT RELEVANT TO THE PRACTICE OF LAW
In completing this section, consider not only your own views of your behavior, but how others have viewed it. For example, if you believe that the answer to Q.57 is 'No', but others have told you that you have trouble communicating, you should answer 'Yes' and explain the circumstances.
These questions are your opportunity to show the Character and Fitness Committee that you understand the qualifications necessary to be an ethical attorney. It is also your opportunity to consider your past actions and behaviors and the bearing they might have on your character and fitness to practice law.
Examples provided in parentheses are meant as a guide; they are not exclusive.
57. Have you ever or do you currently have difficulty communicating with others in an organized, clear, and professional manner? If yes, complete Form H . Yes No
58. Have you ever or do you currently struggle to act diligently and reliably in fulfilling your obligations to others? (Examples: failing to comply with deadlines or time constraints, frequent or excessive work absences, etc.). If yes, Yes No complete Form H .
59. Have you ever or do you currently fail to conduct your business, fiduciary and financial dealings in an honest, Yes No trustworthy and competent manner? If yes, complete Form H .
60. Within the last five years have you used illegal drugs or substances, or prescription medications without the authorization or supervision of a licensed health care professional, or in a manner contrary to the health care Yes No professional's recommendations? If yes, complete Form H .
61. Within the last five years have you conducted yourself in such a manner as to endanger the health or safety of yourself or others? (Examples: suicide attempts, reckless driving, substance abuse). If yes, complete Form H . Yes No
62. Within the past ten years have you suffered from, been diagnosed with, or been tested for bipolar I disorder, schizophrenia, pedophilia, voyeurism, exhibitionism, kleptomania, pyromania, delusional disorder or any psychotic Yes No disorder? If yes, complete Form H .
63. Do you have a current condition or impairment (including, but not limited to, substance abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition) which has not been or is not currently being treated effectively or Yes No for which the treatment is unstable? If yes, complete Form H .
64. Are there any other incidents, issues, or behaviors, not herein before described, having bearing on your character or fitness for admission to the Bar? This would include, but is not limited to, excessive alcohol use (e.g. drinking at work, binge drinking) or illegal activities (e.g. domestic abuse, drunk driving, stealing) that may not have come to the Yes No attention of law enforcement. If yes, complete Form H.. PREVIOUS LAW PRACTICE
65. Have you been a member in good standing and actively licensed to practice law in every jurisdiction where admitted since the date of admission? Yes No All applicants must provide a Certificate of Good Standing from every jurisdiction where admitted , including the USPTO. This document must be dated less than 30 days prior to the date you file the application.
If no, please provide a complete explanation:
66. Have there ever been or are there now any public or private, formal or informal claims, allegations, complaints, charges, or grievances concerning your conduct as an attorney? If yes, complete Form I . Yes No
All applicants must submit a Disciplinary History(a.k.a. Certificate of Discipline, Complaint Check, Grievance Letter, etc.) from every jurisdiction where admitted . The Disciplinary History must address both public and private complaints or discipline and should affirmatively state whether or not there have ever been complaints filed against you.
In answering this question, you are not to rely on memory or whether you have ever received a notice from a jurisdiction's disciplinary authority, as it is possible a claim was made without your knowledge. You must contact the authority in question and obtain the required disciplinary history to verify if there have ever been any complaints, charges, etc. You must answer 'Yes' to this question even if the claim or allegation was dismissed without action.
67. Have you ever been disbarred, suspended, censured, sanctioned, disciplined or otherwise reprimanded or disqualified, whether publicly or privately, as an attorney? If yes, complete Form I. Yes No
Applicants who have been disciplined in another jurisdiction must resolve the discipline and be back in good standing before filing an application
68. Have you ever been sanctioned in a legal matter or have you ever been disqualified from participating in any case? If yes, complete Form I. Yes No
GENERAL REFERENCES
69. Give the names and addresses of two individuals generally known to you whom you have asked to fill out the Character Reference Form on your behalf. References cannot come from people who are related to you by blood or marriage, romantic partners, law school classmates from the same graduating class, or current employees.
First Name: Last Name:
Employer:
Occupation:
Address1:
Address2:
City: ST: Zip: Email:
Check if address is: Residence Business
Years known*: *Note: When entering "Years Known" use only whole numbers; do not use any special characters such as the 'less than' symbol.
First Name: Last Name:
Employer:
Occupation:
Address1:
Address2:
City: ST: Zip: Email:
Check if address is: Residence Business
Years known: ATTORNEY REFERENCES
70. Give the names and addresses of two attorneys whom you have asked to fill out the Character Reference Form on your behalf. References cannot come from people who are related to you by blood or marriage, romantic partners, law school classmates from the same graduating class, or current employees. The attorneys listed here must be different from any listed under Questions 69 and 71.
First Name: Last Name:
Employer:
Occupation:
Address1:
Address2:
City: ST: Zip: Email:
Check if address is: Residence Business
Years known:
First Name: Last Name:
Employer:
Occupation:
Address1:
Address2:
City: ST: Zip: Email:
Check if address is: Residence Business
Years known: EMPLOYER REFERENCES
71. Give the names and addresses of two employers (current or former) whom you have asked to fill out the Character Reference Form on your behalf. References cannot come from people who are related to you by blood or marriage, romantic partners, law school classmates from the same graduating class, or current employees. The attorneys listed here must be different from any listed under Questions 69 and 70.
If you have never been employed or have only had one employer, you may substitute clients or law school professors.
First Name: Last Name:
Employer:
Occupation:
Address1:
Address2:
City: ST: Zip: Email:
Check if address is: Residence Business
Years known:
First Name: Last Name:
Employer:
Occupation:
Address1:
Address2:
City: ST: Zip: Email:
Check if address is: Residence Business
Years known:
Version 1.5.2.90