Form 10 - Connecticut Bar Examining Committee - July 14 Page 2

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Form 10

JULY 14

Connecticut Bar Examining Committee

(Name & Address of personal reference)

Applicant:

This applicant has filed for admission to the practice of law in Connecticut. We are conducting a routine investigation into his/her character and fitness

to become an attorney. We would appreciate your candid evaluation of the applicant. Please complete this form in its entirety. A personal letter will

not be accepted in lieu of this form; however, a personal letter may be attached hereto. This form has been sent to you by the applicant pursuant to the

Bar Examining Committee’s directions. It must not be sent back to the applicant, but sent directly to the Committee. The applicant was instructed to

enclose a prepaid envelope addressed to the Committee. Thank you for your time. The Committee must receive this completed form by

September 2, 2014.

1. How long have you known the applicant? __________________________

2. Are you related to the applicant? ____ If so, in what way___________________________

3. Would you recommend the applicant for a position of trust?________

If not, please tell us why. _____________________________________________________

_______________________________________________________________________

4. To your knowledge has the applicant ever been:

YES NO

[ ]

[ ] Arrested or convicted of a crime

[ ]

[ ] Accused of a violation of trust

[ ]

[ ] Dropped, suspended from, disciplined or placed on probation by an educational institution

[ ]

[ ] A party to a law suit (including bankruptcy)

[ ]

[ ] Treated for the use of drugs, narcotics or alcohol

[ ]

[ ] Denied admission to the bar of any jurisdiction

[ ]

[ ] Delinquent in any financial obligation

If you answered "yes" to any of these questions, please tell us about it. You may also use this space for any

additional comments you wish to make about the applicant._______________________________

________________________________________________________________________

5. To your knowledge is the applicant currently suffering from a disability which would impair the

applicant's ability to practice law? ____________ If so, explain. __________________________

______________________________________________________________________

________________________

_______________________________

Print Name

Signature

Sworn to before me this

_____ day of __________, 20___.

_______________________

Notary Public

Please note: Any information that you provide will be held in confidence unless it is used to establish probable cause to deny the applicant's admission

to the bar.

Return address:

CT Bar Examining Committee

July 2014 Bar Examination

Reference Letter Department

100 Washington Street

Hartford, CT 06106-4411