Ct Bar Examining Committee - Form Ahc9 printable pdf download

Form AHC9

Connecticut Bar Examining Committee

Administrative Office

100 Washington Street

Hartford, CT 06106-4411

CERTIFICATE OF DEAN OF LAW SCHOOL

To the applicant: This form should be forwarded to the Dean of your law school or other appropriate official for completion. Type your name in

the place provided below (Name of Applicant) and sign the authorization to release law school records.

I hereby authorize my law school to release to the Connecticut Bar Examining Committee my final transcript and any other information in my law

school record relevant to my application for registration as authorized house counsel in Connecticut.

______________________________________

_______________________________________

Applicant’s signature

SSN or LS ID #

To the law school: This form must be sent directly to the administrative office of the Bar Examining Committee. An official, final transcript must

be attached to this form. Faxes are not accepted.

________________________________

Name of Applicant

I, __________________________________________, hereby certify that I am the ____________________________________

(Name of Official)

(Title)

of __________________________________________; that ___________________________________________________

(Law School)

(Applicant’s Name)

entered the law school on ___________________________ and that the degree of JD was conferred on ________________ and that

(Date)

[ ] there are/ [ ] there are not matters known to me or contained in the applicant’s record which may reflect adversely on the applicant’s good

moral character and/or fitness to provide legal services to an organization as authorized house counsel. I have attached any relevant documents

and/or a written explanation of such matters and/or have marked the appropriate item(s) below:

The applicant’s record reflects that the applicant:

YES NO

[ ]

[ ] 1. Has ever been arrested

[ ]

[ ] 2. Has ever been accused of a violation of trust

[ ]

[ ] 3. Has ever been expelled, suspended, placed on probation or been subject to discipline by any educational institution

[ ]

[ ] 4. Has ever been a party to any legal proceeding

[ ]

[ ] 5. Has any current condition or impairment which in any way affects the applicant’s ability to practice law

[ ]

[ ] 6. Has ever been denied admission to the bar of any jurisdiction

[ ]

[ ] 7. Has ever been delinquent in any of the applicant’s financial obligations

If you have any personal remarks or if the answer to any of the above is “yes”, please provide a short summary of the matter on the back of this

form or on an attached sheet.

I certify that all the information provided above is true and correct to the best of my knowledge and belief.

_______________________________

______________________________________________

(Date/Seal)

Signature of law school official

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Ct Bar Examining Committee - Form Ahc9

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