Application For Admission To Practice Page 2
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2FOR CLERK’S OFFICE USE ONLY:
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Check # ___________ Receipt #____________
UNITED STATES COURT OF APPEALS FOR THE SEVENTH CIRCUIT
219 S. Dearborn Street, Chicago, Illinois 60604
APPLICATION FOR ADMISSION TO PRACTICE
To be completed by Clerk’s Office personnel. Date of OUT OF COURT Admission: __________________________________
Date of IN COURT Admission: ___________________________ Admitting panel: __________________________________
Applicant Information (Please type or print neatly.)
APPLICANT’S NAME: __________________________________________________________________________________
SOCIAL SECURITY NUMBER (last four digits only): __________________________________________________________
NAME OF FIRM OR AGENCY: ___________________________________________________________________________
BUSINESS ADDRESS (physical location/mailbox): ____________________________________________________________
______________________________________________________________________________________________________
E - MAIL ADDRESS: ___________________________________________________________________________________
BUSINESS TELEPHONE NUMBER: ___________________________________ FAX: ______________________________
DATE FIRST ADMITTED (TO ANY BAR): _________________________________________________________________
STATE(S) IN WHICH APPLICANT IS ADMITTED TO PRACTICE: _____________________________________________
______________________________________________________________________________________________________
HAVE YOU EVER RECEIVED ANY FORM OF DISCIPLINE (INCLUDING A PRIVATE REPRIMAND OR A SANCTION)
FROM A COURT OR A LAWYERS DISCIPLINARY AUTHORITY SINCE YOU WERE FIRST ADMITTED TO
PRACTICE LAW? __________________________________________________________________________________
IF THE ANSWER IS OTHER THAN NO, PLEASE STATE ON AN ATTACHED SHEET WHAT HAPPENED AND
INCLUDE A COPY OF EACH RELEVANT ORDER.
Fee Information
The payment of the $176.00 admission fee due under 28 U.S.C. § 1913 and the $15.00 local fee due under Circuit Rule 46 should be made
electronically via Pay.gov, after the application submission process using the Electronic Case Filing (ECF) System. Access to the ECF
system is available at
Fee Submitted
OR
Fee Waived:
Appointed counsel in this court
Attorney employed by federal government
I hereby certify that the above information is correct and complete. Further, I hereby certify that I have read the “STANDARDS FOR
PROFESSIONAL CONDUCT WITHIN THE SEVENTH FEDERAL JUDICIAL CIRCUIT” and agree to conduct myself in accordance
therewith. Finally, I solemnly swear (or affirm) that I will conduct myself as an attorney and counselor of this court, uprightly and
according to law; and that I will support the Constitution of the United States.
______________________________________________________________
(Signature of Applicant)
______________________________________________________________________________________________________________
Sponsor Information
SPONSOR’S NAME: _____________________________________________________________________________________
SPONSOR’S ADDRESS: __________________________________________________________________________________
WHEN ADMITTED TO PRACTICE: ________________________________________________________________________
WHEN ADMITTED TO THIS COURT: ________________________________________________________________________
I hereby vouch for the personal integrity and professional ethics of the applicant and respectfully move that said applicant be
admitted as an attorney and counselor of this court.
______________________________________________________________
(Signature of Sponsor)
Reproduction of this form is authorized. (February 2016)
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