Criminal Justice Act Panel Application

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CRIMINAL JUSTICE ACT PANEL APPLICATION
WESTERN DISTRICT OF OKLAHOMA
I.
Identification:
Name: __________________________________________________________________
Last
First
Middle Initial
Office address, including name of firm:
Office Telephone: ___________________________ Office Facsimile: ___________________
Cellular Phone: _________________________________________________________________
E-mail Address: ________________________________________________________________
Social Security Number __________ - _____ - __________
II.
Legal Education:
What law degree(s) have you received? Specify the law school and the date the degree was
received. (E.g., J.D., OCU, 1975).
III.
Law Licenses:
A.
Identify the states in which you are currently admitted to practice law, including the date of
admission. (E.g., Oklahoma, 1987).
B.
Identify all federal courts in which you are currently admitted to practice, including the date
of admission.

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