Questionnaire And Application For Membership
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7QUESTIONNAIRE AND APPLICATION FOR MEMBERSHIP
IN THE CRIMINAL JUSTICE ACT PANEL
FOR THE UNITED STATES DISTRICT COURT FOR
THE MIDDLE DISTRICT OF FLORIDA
The following Questionnaire and Application is to be completed by attorneys requesting to represent
defendants under the provisions of the Criminal Justice Act in the United States District Court for the Middle District
of Florida:
THE APPLICANT IS HEREWITH APPLYING FOR APPOINTMENT AS A CJA PANEL ATTORNEY.
1.
Name:
FL Bar #
Firm Name:
Office Address:
@
E-Mail Address:
Office Phone:
Fax Number:
Home Phone:
2.
Education and Bar Admissions:
Graduated from
School of Law.
Year:
01/01/01
Admitted to practice in the State of Florida on:
Admitted to practice in the United States
01/01/01
District Court for the Middle District of Florida on:
Admitted to practice in the United States
01/01/01
Court of Appeals for the Eleventh Circuit on:
Admitted to practice in the United States
01/01/01
Supreme Court on:
Application for Membership in Criminal Justice Act
Middle District of Florida
Revised: September 17, 2015
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