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United States Bankruptcy Court
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Western District of Washington
APPLICATION FOR LEAVE TO APPEAR AS A LEGAL INTERN
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Pursuant to Local Rules W.D. Wash. LCR 83.4 of the United States District Court for the
Western District of Washington, and Local Rule W.D. Wash. Bankr. 2090-1, I,
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______________________________, hereby apply for permission to appear and
participate as a legal intern under the supervision of
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________________________________.
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I am a student duly enrolled and in good academic standing at ____________________
_________________________________ and I have completed:
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___ two-thirds of my three year course of study;
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___ five-eighths of my four year course of study;
OR
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Nine months have not expired since my graduation from ____________
_________________________ and I have attached proof thereof.
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I understand that I am charged with knowing and complying with the Washington State
Rules of Professional Conduct, Local Rules W.D. Wash. LCR 83.4 and the Local
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Bankruptcy Rules of the W.D. Washington.
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I declare under penalty of perjury that the foregoing is true and correct.
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Dated this _______ day of ______________, 20__.
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________________________________________
Signature of Applicant
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Statement of Supervising Attorney
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I,____________________________________, am prepared to supervise the applicant
in accordance with Local Rules W.D. Wash. LCR 83.4(d) and Local Rules W.D. Wash.
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Bankr. 2090-1. I hereby certify that I am admitted to practice before this Court and that
I have been actively engaged in the practice of law for at least three years.
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Dated this _______ day of _____________, 20__.
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________________________________________
Signature of Supervising Attorney
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Name of supervising attorney: _____________________________________
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Washington State Bar number: ____________________________________
Law Firm: _____________________________________________________
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Street Address: ____________________________
Rm/Suite: ___________
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City/State/Zip: _________________________________________________
Phone: _____________________________
Application for Leave to Appear as Legal Intern
Local Forms W.D. Wash. Bankr., Form 4
Eff. 04/15