Application For Admission To Practice Page 2
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1
2
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5U
S
A
C
NITED
TATES
OURT OF
PPEALS
D
C
C
ISTRICT OF
OLUMBIA
IRCUIT
1. Name
(First)
(Middle)
(Last)
2. Prefix
3. Place of Birth
4. DOB
(Mr., Mrs., Ms., etc.)
5. Name of Parents:
(a) Mother's maiden name
(b) Father's name
6. Applicant's residence address.
(Street)
(City)
(State)
(Zip)
(Phone)
7. Office address (including street and number and name of law firm or organization) of applicant:
Firm Name:
Address:
(
(FAX)
Phone)
(E-Mail)
8. List all law schools which you have attended, setting forth whatever degree(s) received and date(s) of receipt.
9. List all Bar examinations that you have taken, give the approximate date of each such examination, and
indicate those on which you received a passing grade.
10. Give the DATE of admission and your BAR NUMBER for the courts listed below to which you have been
admitted.Write "NOT ADMITTED'' where appropriate. Indicate whether admission was based upon examination
motion or diploma privilege.
(a) Supreme Court of the United States
(bar #)
(date)
(b) US Court of Appeals for the
Circuit
(bar #)
(date)
(c) US District Court for the
District of
(date)
(bar #)
(d) Highest Court(s) of the State(s) (Territory) of
(date)
(bar #)
(e) District of Columbia Court of Appeals
(bar #)
(date)
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USCA Form 81
Rev. Dec. 2016
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