State Bar of Nevada
Application for Admission
Credit Report Information Form
Please complete the following form as part of your Application for Admission to the State Bar of Nevada. Complete a
separate form for each account in question. Make additional copies of the form if needed. Answer and complete all items
on this form. If an item requiring your response is not applicable, write “N/A”. Use separate sheets if more space is
needed. This form is to be completed honestly and to the best of your knowledge after reasonable inquiry. If you are
unaware of the debt, please obtain a copy of your Transunion credit report to review the account. Please provide all
required documentation for the account listed. All applicants must provide proof that each account in question has either
(a) been paid; (b) that payment arrangements have been made; or (c) that the debt is currently under dispute. This proof
may include account statements, letters from the creditor or lender, internet account printouts, etc.
1. Name and complete address of creditor or lender
:
Name: ______________________________________________________________________________________________
Address: _____________________________________________________________________________________________
City: _____________________________ State: _______ Zip: _________ Telephone Number: _______________________
2. Account Number(s): _________________________________________
3. Date of initial delinquent account(s): _________________________________________
4. Describe the nature of the obligation(s) and reason for arrearage
:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
5. Total Current Amount Due, Outstanding, Owed or Unpaid
____________________________________
:
6. Has the account been sent to collections?
Yes
No
7. Have you made or plan to make payments or payment arrangements?
Yes
No
8. Is the account currently under dispute?
Yes
No
9. Current Status of the obligation(s) such as past due, current on payments, deferment, forbearance, etc.:
____________________________________________________________________________________
10. If you are currently unable to make payments or payment arrangements, please provide an explanation
:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
For online submissions, click “Save a Copy” and email the completed form. Attach the saved file and scans of
all other required documentation to the email. For hardcopy submissions, click “Print Form” and mail all
required documentation to the State Bar of Nevada, Admissions Department, 3100 W. Charleston Blvd., Suite
100, Las Vegas, NV 89102.
Save a Copy
Print Form
Save a Copy
Print Form