| General Information |
| Personal Information |
| First Name | John |
| Middle Name | Frederick |
| Last Name | Example |
| Suffix | Jr. |
| NCBE Number | N10000000 |
| Last Four of Social Security Number |
| Date of Birth | January 10, 1961 |
| Contact Information |
| Physical Address |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Email Address | sample@email.com |
| Primary Phone | (812) 111-5100 |
| Additional Phone | (812) 121-5203 |
| Mailing Address |
| Address 1 | 3855 Lake Clearwater Place |
| Address 2 | Apt. 222 |
| City | Sarasota |
| State | Florida |
| Zip Code | 90210 |
| Country | United States of America |
| Other Names |
| Have you ever had your name changed by marriage or civil union, divorce, court order, or been known by any name (including birth names or aliases) other than the name which you entered into the application Profile section of this application? |
| List all names and corresponding dates |
| Name |
| Date From |
| Date To |
| Was name change pursuant to court order? |
| NOTE: You must upload a copy of the petition of name change and the final court order for such name change. |
| Provide a detailed explanation | ||
| Marriage |
| Are you currently married? |
| Spouse's Full Name |
| Date of Marriage |
| Location of Marriage |
| City |
| State |
| Country |
| Have you ever been divorced, legally separated or had a marriage annulled or set aside? |
| NOTE: You must upload a copy of all court documents pertaining to marital or legal termination, including decrees, any separation agreement(s), permanent or final orders, and any other documentation relating to each marital or legal termination. |
| Name of Former Spouse |
| Date of Action (Divorce, Annulment, etc.) |
| Location of Action |
| City |
| State |
| Country |
| Have you ever been required to pay alimony, maintenance or child support payments as a result of a divorce, annulment or other court proceeding? |
| NOTE: You must upload a notarized statement from the person to whom payments are made of your compliance with support payments, or a record of payment from the court or government registry through which payments are made. |
| Type of Payment |
| Name of Person You Are Required to Pay Support |
| First Name |
| Middle Name |
| Last Name |
| Last Known Address of Person Receiving Support Payments |
| Address 1 |
| Address 2 |
| City |
| State |
| Country |
| Parents |
| Parent 1 |
| Parent 1 Name (designate maiden name, if applicable, in () parentheses) |
| Is Parent 1 deceased? |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Parent 2 |
| Parent 2 Name (designate maiden name, if applicable, in () parentheses) |
| Is Parent 2 deceased? |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Driver’s License |
| List every state where you have been licensed to drive in the last five (5) years. |
| You must upload an official original (photocopies will not be accepted) of your driving record from the Department of Motor Vehicles or Public Safety in each jurisdiction where you have been licensed to drive or have resided in the last five (5) years. Driving records must be currently dated (no more than 30 days prior to the date your application is submitted). Driver histories obtained through internet sources will NOT be accepted unless they were obtained directly from the jurisdiction’s Department of Motor Vehicles official website. |
| NOTE: If you do not have a driver’s license, state the reason why and upload a copy of your state-issued Identification Card. If your license is or has been restricted for any reason other than eyeglasses or contacts, include an explanation in the box provided below. |
| State Issued |
| Expiration Date |
| Driver’s License Number (If no Driver’s License, provide State Issued ID number) |
| Is/has your driver’s license ever been restricted? |
| Explanation of restriction(s) | ||
| Since attaining the legal driving age, has your license to operate a motor vehicle ever been suspended or revoked? |
| State Issued |
| Driver’s License Number |
| Dates of Suspension/Revocation |
| Reason for Suspension/Revocation | ||
| Citizenship |
| Are you a citizen of the United States? |
| Are you authorized by the US government to work in the US? |
| Please provide details regarding your immigration status in the comments box | ||
| Residences |
| List in chronological order, beginning with your current address, every residence where you have lived for 90 days or longer during the past ten years OR since you were first admitted to practice law in any jurisdiction – whichever is longer, but not prior to your 18th birthday. You must list every residence so that there are no gaps between residences. This means that the month and year upon which the prior residence ended (Date To), must be repeated as the starting point (Date From) of the next residence. |
| Date From |
| Date To |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Academic History |
| College/University |
| List all colleges or universities, other than law schools, you attended. |
| NOTE: If you attended a college or university from which you did not graduate, or received no credit, provide a detailed explanation of why no credit was received. |
| Name of College/University |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Date From |
| Date To |
| Degree Earned (or explanation for no degree or credit) |
| Law School |
| List all law schools you have attended, whether you graduated or not. Indicate the Law School from which you have/will receive a Juris Doctor or Bachelor of Laws degree. |
| Law School Name |
| Enter Law School Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Enrollment Status (e.g., attended, graduated) |
| Date From |
| Date To |
| Degree |
| Explanation for no degree or credit | ||
| Date Degree Conferred or Expected to be Conferred |
| City |
| State |
| Zip Code |
| Country |
| Enrollment Status (e.g., attended, graduated) |
| Date From |
| Date To |
| Degree |
| Explanation for no degree or credit | ||
| Date Degree Conferred or Expected to be Conferred |
| Academic Conduct |
| Have you ever been accused of a violation of an honor code or student conduct code, warned or advised of any misconduct, accused of and/or investigated for any misconduct, placed on scholastic or disciplinary or any other form of probation, sanctioned, suspended, requested or advised to discontinue your studies, dropped, expelled or requested to resign or otherwise subjected to discipline by any college, university, law school or other post-secondary institution? |
| Regardless of whether the record has been expunged, canceled or annulled, or whether no record was made, have you ever been accused of cheating, plagiarism, or personal or academic dishonesty at any college, university, law school or post-secondary institution you attended? |
| Provide a personal statement in the space below for each incident which includes: details of each incident, its disposition, and the punishment imposed, if any. |
| NOTE: You will need to upload substantiating documentation, including any and all relevant documents contained in your student file. |
| Name of School/Institution |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| Date of Incident/Conduct |
| Final Disposition |
| Date of Disposition |
| Detailed Explanation | ||
| NOTE: This statement should contain a description of the factual events and actions which led to this incident/conduct. You should include your perspective of the circumstances, reasons, or situations which contributed to the incident/conduct disclosed. This includes any information or explanation which mitigates or lessons the severity of the actions or conduct and to illustrate rehabilitation. |
| Application(s) / License History |
| Previous Attorney Licensing Application(s) |
| Are there any jurisdictions in which you have applied for a license to practice law in any jurisdiction that DID NOT RESULT, OR HAS NOT RESULTED, in your admission to practice law in that jurisdiction? |
List all the jurisdictions to which you have applied for a license to practice law but have not been admitted, including but not limited to:
|
| Jurisdiction |
| Country |
| Type of Application |
| Explain Other | ||
| Date of Exam (If Applicable) |
| Outcome |
| Explain Other Outcome | ||
| Have you ever had your fitness to practice law questioned through an informal interview, formal hearing, or through any other means? |
| Jurisdiction |
| Country |
| Date of Interview/Hearing |
| Provide a detailed explanation of each instance including the reason(s) for the interview or hearing, nature of interview or hearing and the final outcome. | ||
| NOTE: You must upload substantiating documentation from the applicable agency(ies). |
| Have you ever been denied admission to the practice of law in any jurisdiction (other than for failure of the bar examination), been denied access to the bar exam of any jurisdiction, been accused of misconduct during the administration of any bar exam or had an exam score nullified? |
| Jurisdiction |
| Country |
| Agency |
| Provide a detailed explanation including the reason(s) you were denied. | ||
| NOTE: You must upload substantiating documentation from the applicable agency(ies). |
| Attorney Licensing |
| Have you ever been licensed to practice law in any jurisdiction? |
| List separately every jurisdiction and/or court where you are currently or ever have been admitted to practice law. |
| NOTE: An original certificate of good standing, original disciplinary authority certificate for each jurisdiction admitted is required. Only certificates issued within 90 days of the filing of this application will be accepted. |
| Jurisdiction |
| Country |
| Courts |
| License Number |
| Date of Admission |
| How Admitted |
| License Status |
| Explain Other |
| Has your license to practice law in this jurisdiction ever been limited, restricted, suspended, disbarred or revoked (include periods of inactive or nonresident status and any period of administrative suspension or transfer to disability status) since the date of your admission? |
| Jurisdiction |
| Date From |
| Date To |
| Nature of limitation, suspension, disbarment or revocation. |
| Agency/Authority in possession of records relating to the matter. |
| Agency/Authority Address |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Facts associated with limitation suspension, disbarment or revocation. | ||
| Judicial/Public Office |
| Have you ever held any public or judicial office? |
| Title of Office Held |
| Location of Office Held |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Date From |
| Date To |
| Reason for Termination (Put “N/A” if not applicable) | ||
| Other Professional Licensing |
| Have you ever applied for a professional, state or local license in order to pursue a career in a field (other than as an attorney) requiring licensure (e.g., CPA, real estate agent, physician, nurse, patent practitioner, etc.)? |
| Type of License |
| Date of Application |
| Date of Licensure |
| Licensing Authority |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| License Status |
| Provide an explanation in the comments box. (If no license was issued upon application, please explain.) | ||
| Was an examination required to obtain this license? |
| Was proof of good character required to obtain this license? |
| Attorney/Public Office/Professional License Conduct |
| Are you currently the subject of any allegations, charges, complaints, disciplinary or grievance actions (formal or informal) and/or have you ever been suspended, censured, reprimanded, publicly or privately, or disqualified as an attorney, LLP, a member of any other profession, or as a holder of public office? |
| Provide the following information for each matter. |
| NOTE: You must also upload a copy of the original charge, complaint or grievance and final disposition, if any, from the appropriate discipline authority. |
| Jurisdiction |
| Country |
| Original Charge/Complaint |
| Date of Charge/Complaint |
| Case Number (if applicable) |
| Name of agency/authority in possession of the records |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| Give a detailed narrative of the circumstances surrounding the charge. | ||
| NOTE: This statement should contain a description of the factual events and actions which led to this incident/conduct. The explanation should include your perspective of the circumstances, reasons, or situations which contributed to the incident/conduct disclosed. This includes any information or explanation which mitigates or lessens the severity of the actions or conduct and to illustrate rehabilitation. |
| Decision or Action Taken |
| Date of Decision/Action |
| Have you ever had your fitness to practice law questioned through an informal interview, formal hearing, or through any other means? |
| Jurisdiction |
| Date of Application |
| Applicable Agency |
| Agency/Authority Address |
| Address 1 |
| Address 2 |
| City |
| State |
| ZIP Code |
| Country |
| Reason for Inquiry |
| Nature of Questioning | ||
| Final Outcome | ||
| Anticipate Admission Date (if application is pending) |
| Unauthorized Practice of Law |
| Have you ever been the subject of any formal allegations, charges, complaints or grievances (formal or informal) alleging that you engaged in the unauthorized practice of law, including any pending matters? |
| NOTE: You must upload a copy of the original charge, complaint or grievance and final disposition, if any, from the appropriate disciplinary authority. |
| Jurisdiction |
| Country |
| Original Charge/Complaint |
| Date of Charge/Complaint |
| Case Number (if applicable) |
| Name of agency/authority in possession of the records |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| Give a detailed narrative of the circumstances surrounding the charge. | ||
| NOTE: This statement should contain a description of the factual events and actions which led to this incident/conduct. The explanation should include your perspective of the circumstances, reasons, or situations which contributed to the incident/conduct disclosed. This includes any information or explanation which mitigates or lessens the severity of the actions or conduct and to illustrate rehabilitation. |
| Decision or Action Taken |
| Date of Decision/Action |
| Bar Associations |
| Bar Associations |
| Are you currently or have you ever been a member of any bar association? (Include all optional or mandatory bar associations.) |
| Provide the full name and address of each mandatory or voluntary bar association of which you have been or are currently a member. |
| Dates of Membership |
| From |
| To |
| Name of Bar Association |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| If not still a member, provide an explanation | ||
| Employment History |
| Employment History |
| For each employment section, list all employment and unemployment in chronological order for the last ten years starting with the most recent. Do NOT leave any GAPS during that time frame. |
NOTE: Employment (Licensed Attorney and Non-Attorney) - In this context, employment includes part-time and full-time employment, self-employment, internships and externships (paid or unpaid), clerkships, regular work, professional work, volunteer work and temporary or seasonal jobs. Unemployment - Provide a brief, but specific, description of your activities while unemployed for a period of 30 days or more (seeking employment, preparing for law school, attending school name, vacation, studying for bar exam). Military - Provide information on any military service you may have done. Employment Verifying References - If an employer is no longer in business, or you were self-employed or employed by a relative, provide the name and contact information of a verifying reference. Do not include yourself, any person related to you by blood or marriage, under your supervision, anyone who resides at your current residence or any individuals already referred to in your application as a verifying reference. |
| Licensed Attorney Employment |
| Have you ever been or are you currently employed as a licensed attorney? You must include all licensed attorney employment since you were first admitted to practice law in any jurisdiction. Employment encompasses all part-time and full-time employment, whether paid or unpaid, for which a law license was required. |
| NOTE: Do not include in response to this question any work as a law clerk, paralegal, or other non-attorney positions. Those may be entered under the Non-Attorney Employment section. |
| Job Title or Position Held |
| Start Date |
| End Date |
| NOTE: If you have been Disciplined, Terminated, Resigned in Lieu of Termination, Laid Off, Suspended, Disciplinary Discharge, you must give a description of the factual events and actions which led to this termination. You must include in the explanation your perspective of the circumstances, reasons, or situations which contributed to the termination, along with any information or explanation which mitigates or lessons the severity of your actions or conduct and to illustrate rehabilitation. |
| Reason for Leaving |
| Please Explain | ||
| Employer Name (even if no longer in business) |
| Supervisor Name |
| Supervisor Mailing Address |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| Supervisor’s Email |
| Is this employer no longer in business, or were you self-employed or employed through a temporary agency? |
| Provide the name and contact information of a verifying reference or temporary agency, whichever is applicable. |
| Verifying Reference or Temporary Agency Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Verifying Reference or Temporary Agency Telephone Number |
| Verifying Reference or Temporary Agency Email |
| Briefly describe how this verifying reference is familiar with your employment (e.g. former co-worker, CPA, client, etc.) | ||
| Non-Attorney Employment |
| For the ten year period preceding this application have you had, or are you currently employed in non- attorney employment (e.g., paralegal, law clerk, internships and externships [paid or unpaid], clerkships, regular work, professional work, volunteer work, etc.)? |
| NOTE: Do not include work as a licensed attorney. |
| Job Title or Position Held |
| Start Date |
| End Date |
| NOTE: If you have been terminated, suspended, disciplined or permitted to resign in lieu of termination, you must give a description of the factual events and actions which led to this termination. You must include in the explanation your perspective of the circumstances, reasons, or situations which contributed to the termination, along with any information or explanation which mitigates or lessons the severity of your actions or conduct and to illustrate rehabilitation. |
| Reason for Leaving |
| Please Explain | ||
| Employer Name (even if no longer in business) |
| Supervisor Name |
| Supervisor Mailing Address |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| Supervisor’s Email |
| Is this employer no longer in business, or were you self-employed or employed through a temporary agency? |
| Provide the name and contact information of a verifying reference or temporary agency, whichever is applicable. |
| Verifying Reference or Temporary Agency Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Verifying Reference or Temporary Agency Telephone Number |
| Verifying Reference or Temporary Agency Email |
| Briefly describe how this verifying reference is familiar with your employment (e.g. former co-worker, CPA, client, etc.) | ||
| Unemployment |
| For the ten year period preceding this application, are you now or have you been unemployed for 30 days or more? |
| Start Date |
| End Date |
| Description/Reason for Unemployment | ||
| Military Service |
| Have you ever been a member of the armed forces of the United States, including the National Guard or any of the reserve components, or of any foreign country? |
| Branch |
| Provide Military Branch |
| State |
| Serial Number |
| Rank |
| Dates of Service |
| From |
| To |
| Are you presently a member of the armed forces? |
| Upload a copy of your Report(s) of Separation (e.g., DD FORM 214-Member Copy #4, NGB Form 22, etc.). The Report of Separation must indicate your character of service. |
| Did you receive an honorable discharge? |
| Detailed Explanation | ||
| Were you the subject of charges in any court-martial? |
| Detailed Explanation | ||
| Date of Action |
| Result (including any punishment) |
| Were you allowed to resign in lieu of court-martial? |
| Detailed Explanation | ||
| Date of Action |
| Result (including any punishment) |
| Did you receive non-judicial punishment (ART. 15 UCMJ)? |
| Detailed Explanation | ||
| Date of Action |
| Result (including any punishment) |
| Have you received a discharge for medical or other than “honorable” reasons? |
| Detailed Explanation | ||
| Date of Action |
| Result (including any punishment) |
| Were you administratively discharged? |
| Detailed Explanation | ||
| Date of Action |
| Result (including any punishment) |
| Legal Proceedings |
| Legal Proceedings |
| You are required to answer the questions in this section completely, irrespective of any statute, administrative rule, court order or legal or administrative proceeding expunging the information required herein from any record or purporting to authorize any person to deny the existence of such matters, and IRRESPECTIVE OF ANY ADVICE FROM ANY SOURCE (INCLUDING LEGAL COUNSEL) THAT SUCH INFORMATION NEED NOT BE DISCLOSED. |
| Civil History |
| Have you been named a party to any type of civil action? Do NOT include bankruptcy or divorce. |
| NOTE: You must upload a copy of the original petition or complaint, pleadings, judgments and/or final orders from the court. If you were the defendant, a copy of the satisfaction of any judgment for each suit. |
| Title of Civil Case |
| Court File Number |
| Date Action Filed |
| Name of Court |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Plaintiff’s Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Plaintiff’s Attorney |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Defendant’s Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Defendant’s Attorney |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Description of Petition or Complaint | ||
| NOTE: Provide a detailed explanation of the factual events and actions which led to this civil action. You must include in the explanation your perspective of the circumstances, reasons, or situations which contributed to the civil action, along with any information or explanation which mitigates or lessons the severity of your actions or conduct and to illustrate rehabilitation. |
| Final Disposition |
| Date of Disposition |
| If the disposition of this matter resulted in a judgment, was the judgment satisfied? |
| Have you ever had a complaint or action (including but not limited to, allegations of fraud, deceit, misrepresentation, forgery or malpractice) initiated against you in any administrative forum? |
| NOTE: You must upload a copy of the administrative record and final disposition from the administrative authority. |
| Title of Action/Complaint |
| File Number |
| Date Action Filed |
| Name of Administrative Forum or Body Involved |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Name of Investigative Agency (Body, Board, Commission, Committee, etc.) |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Description of Action or Complaint | ||
| NOTE: Provide a detailed explanation of the factual events and actions which led to this administrative complaint or action. You must include in the explanation your perspective of the circumstances, reasons, or situations which contributed to the civil action, along with any information or explanation which mitigates or lessons the severity of your actions or conduct and to illustrate rehabilitation. |
| Final Disposition |
| Date of Disposition |
| Have you ever been held in contempt of court for any reason, have sanctions ever been entered against you or have you ever been disqualified from participating in any case? |
| NOTE: You must upload copies of the order of the contempt and sanction from the court. |
| Type of Action |
| Name of Court |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Description of Action | ||
| NOTE: Provide a detailed explanation of the factual events and actions which led to this administrative complaint or action. You must include in the explanation your perspective of the circumstances, reasons, or situations which contributed to the civil action, along with any information or explanation which mitigates or lessons the severity of your actions or conduct and to illustrate rehabilitation. |
| Final Action Taken |
| Date Action Taken |
| Surety Bond |
| Has any surety on any bond on which you were the principal been required to pay any money on your behalf? |
| NOTE: You must upload a copy of the allegations and final disposition, if any, from the authority responsible for maintaining the record. |
| Name of Bonding Company |
| Reason for Bond |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Amount of money paid on your behalf |
| Date Money Paid |
| Reason for Money Paid | ||
| Criminal History |
| Regardless of whether the record has been sealed, expunged, canceled or annulled, have you ever been investigated, detained, arrested, cited for, charged with, or convicted, imprisoned, placed on probation or parole or forfeited collateral for any offense against the law or ordinance? Matters involving all traffic violations, including alcohol or drug-related traffic violations should be reported in your response to this question. |
| NOTE: In answering this question, include matters that have been dismissed, expunged, sealed, subject to a diversion or a deferred prosecution program or otherwise set aside. You must also report any failure-to-appear charges resulting from any offense(s) and any incident in which you were in violation of a court order (i.e. bond or probation violation, protection order). |
You must upload the following for each incident:
|
| Date of Incident |
| Location of Incident (City, County and State or Country/Province) | ||
| Charge(s) at Time of Arrest |
| Title of Complaint, Indictment or Citation |
| Court File Number |
| Name of Law Enforcement Agency |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Name of Court of Jurisdiction |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Name of Defendant’s Attorney (if any) |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Date of Initial Court Hearing |
| Charge(s) at Time of Initial Court Hearing |
| Date of Final Disposition |
| Charge(s) at Final Disposition |
| Sentence Imposed by Court (include any educational or treatment requirements) | ||
| Detailed factual description of the incident | ||
| NOTE: Provide a detailed explanation of the factual events and actions which led to this offense against the law or ordinance. You must include in the explanation your perspective of the circumstances, reasons, or situations which contributed to the offense, along with any information or explanation which mitigates or lessons the severity of your actions or conduct and to illustrate rehabilitation. If this was a DUI/DWI, provide your BAC level within your explanation. |
| Financial History |
| Financial History |
| You are required to answer the questions in this section completely, irrespective of any statute, administrative rule, court order or legal or administrative proceeding expunging the information required herein from any record or purporting to authorize any person to deny the existence of such matters, and IRRESPECTIVE OF ANY ADVICE FROM ANY SOURCE (INCLUDING LEGAL COUNSEL) THAT SUCH INFORMATION NEED NOT BE DISCLOSED |
| Delinquent Debts |
| Within the past seven (7) years, have you been delinquent by more than 90 days in the payment of any debt, including student loans, had a credit card revoked or canceled, a credit account involuntarily closed, or any debt referred to a collection agency or “charged off” as not collectible? |
| NOTE: You must upload verification of current pay status or satisfaction of debt. |
| Type of Debt |
| Explain Other Type of Debt |
| Type of Action |
| Account Number |
| Original Amount of Debt |
| Current Balance |
| Date of Last Payment |
| Current Status of Debt |
| Name of Creditor |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| If different from above, provide the current creditor or collection agency |
| Collection Agency Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| Provide a detailed explanation. | ||
| NOTE: This explanation should contain a detailed history of the debt and the factual events and actions which led to this debt, including information which mitigates or lessens the severity of your actions or conduct and to illustrate rehabilitation. The explanation should also include any actions taken to collect the debt, any defenses to the debt, the terms of any agreement to repay the debt and the status of that repayment arrangement. |
| Judgments |
| Have any judgments, liens, decrees or orders (including child support, maintenance or alimony) ever been entered against you in favor of a creditor or other entity? |
| NOTE: If you have any tax lien(s), please enter those under the Taxes section. |
List each suit filed against you. |
NOTE: You must upload the following:
|
| Type (Judgment, Lien, Decree, Order) |
| Name of Creditor |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| If different from above, provide the current creditor or collection agency |
| Collection Agency Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Caption of Case |
| Case Number |
| Name of Jurisdiction/Court |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Original Amount of Debt |
| Current Amount of Judgment or Lien (Amount Ordered to Pay) |
| Provide a detailed explanation | ||
| Provide a detailed explanation. NOTE: This explanation should contain the factual events and actions which led to this judgment, lien, decree or order.This includes the terms of any agreement to pay the judgment, and the current status of such an agreement for each suit. |
| Bankruptcy |
| Have you ever filed a petition for bankruptcy or for establishment of a wage earners plan? |
| NOTE: You must upload a copy of the schedule of indebtedness, petition for bankruptcy and the dismissal or the discharge order from the bankruptcy court. |
| Type of Bankruptcy |
| Total Amount of Debt Discharged |
| Date Bankruptcy Filed |
| Case Caption |
| Case Name |
| Name of Bankruptcy Court of Jurisdiction |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Disposition |
| Date of Disposition |
| Provide a detailed explanation | ||
| NOTE: This explanation should contain the history of this bankruptcy and the factual events and actions which led to this bankruptcy.This should include your perspective of the circumstances, reasons or situations that contributed to the bankruptcy and any explanation which mitigates or lessens the severity of your actions or conduct and to illustrate rehabilitation. |
| Were adversary proceedings instituted? |
| Please explain in detail. | ||
| Were there any allegations of fraud? |
| Please explain in detail | ||
| Were any debts not discharged? |
For each creditor, please provide the following:
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| Taxes |
| Do you currently have any outstanding tax liabilities (i.e. tax liens, distraint warrants, etc.) and/or have you ever failed to file federal, state and/or local income tax returns since first becoming obligated to do so by law, excluding years not required to file based on lack of income? |
| List each tax year separately |
| NOTE: You must upload a copy of each year’s tax documentation and any documentation substantiating repayment arrangements, including verification of current pay status or satisfaction. |
| Type (Federal, State, Local) |
| State or Locality (if applicable) |
| Name of Tax Authority |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Tax Year Not Filed |
| Tax Amount Owed or Remaining to be Paid |
| Provide a factual statement explaining the reason(s) the taxes were not timely filed | ||
| NOTE: The explanation should include your perspective of the circumstances, reasons or situations that contributed to the tax delinquency and any explanation which mitigates or lessens the severity of your actions or conduct and to illustrate rehabilitation. |
| Has a tax return, schedule(s) or report been filed? |
| Date Filed Tax Return, Schedule or Report |
| Have you paid the tax owed? |
| Date Tax Paid |
| Current balance of tax still owed. |
| Fitness |
| Fitness Instructions |
The following questions address recent mental health and chemical or psychological dependency matters. The purpose of these questions is to determine the current fitness of an applicant to practice law. The mere fact of treatment for mental health problems or chemical or psychological dependency is not, in itself, a basis on which an applicant is ordinarily denied admission to the Colorado bar. The Office of Attorney and LLP Admissions regularly recommends licensing of individuals who have demonstrated personal responsibility and maturity in dealing with mental health and chemical or psychological dependency issues. The Board encourages applicants who may benefit from treatment to seek it. As indicated in the Rules Governing Admission to the Bar, all proceedings conducted pursuant to Rules are confidential, with certain limited and enumerated exceptions. See Rule 211.1. On occasion a license may be denied when an applicant’s ability to function is impaired in a manner relevant to the practice of law at the time that the licensing decision is made, or when an applicant demonstrates a lack of candor by their responses. Protection of the public that will receive legal services underlies the licensing responsibilities assigned to the Office of Attorney and LLP Admissions. Furthermore, each applicant is responsible for demonstrating that they possess the qualifications necessary to practice law. Your response may include information as to why, in your opinion or that of your treatment provider, your condition will not affect your ability to practice law in a competent and professional manner. The Office of Attorney and LLP Admissions does not, by its questions, seek information that is characterized as situational counseling, such as stress counseling, domestic counseling and grief counseling. Generally, these types of counseling are not viewed as germane to the issue of whether an applicant is qualified to practice law. |
| Fitness |
| Within the past five (5) years, have you exhibited any conduct or behavior that could call into question your ability to practice law in a competent, ethical and professional manner? |
| Provide a detailed explanation | ||
| NOTE: This statement should contain a detailed description of the factual events and actions which led to the conduct or behavior you are disclosing. The explanation should include your perspective of the circumstances, reasons, or situations that contributed to the conduct or behavior, along with any information or explanation that you believe mitigates or lessons the severity of your conduct or behavior and to illustrate rehabilitation. |
| Do you currently have any condition or impairment (including, but not limited to, substance abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition) that in any way affects your ability to practice law in a competent, ethical and professional manner? |
| Identify the condition or impairment |
| Describe how your condition or impairment currently affects your ability to practice law | ||
| NOTE: This statement should contain a detailed description of the current condition or impairment you are disclosing. The explanation should include your perspective of the circumstances, reasons, or situations that contributed to your condition or impairment. |
| Are you receiving any treatment and/or are you involved in a monitoring or support program for this condition or impairment? |
| Describe treatment and/or monitoring program(s) | ||
| NOTE: This statement should contain a detailed description of the current treatment and or monitoring program(s) you are receiving or involved in for your condition or impairment. |
| Dates of Treatment |
| Date From |
| Date To |
| Treatment Physician or Counselor (if applicable) |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| Hospital or Institution (if any) |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| Support or Monitoring Program (if applicable) |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Telephone Number |
| Are the limitations caused by this condition or impairment reduced or ameliorated because you receive ongoing treatment or because you participate in a monitoring or support program? |
| Provide a detailed explanation. | ||
| NOTE: The explanation should include any information or explanation that describes how treatment and/or monitoring/support program(s) reduces or ameliorates the condition or impairment you disclosed. |
| Within the past five (5) years, have you asserted any condition or impairment as a defense, in mitigation, or as an explanation for your conduct in the course of any inquiry, investigation, or administrative or judicial proceeding by an educational institution, government agency, professional organization or licensing authority? |
| Provide the name of the entity where the issue was raised (i.e. court, agency, etc.) |
| Address 1 |
| Address 2 |
| City |
| State |
| Zip Code |
| Country |
| Nature of Proceedings |
| Final Disposition |
| Date of Disposition |
| Provide a detailed explanation | ||
| NOTE: This statement should contain a detailed description of how your condition or impairment was a defense for your conduct or behavior. The explanation should include your perspective of the circumstances, reasons, or situations that contributed to your conduct or behavior, along with any information or explanation that you believe mitigates or lessens the severity of your conduct or behavior and to illustrate rehabilitation. |
| Have you ever been declared incompetent or had a conservator appointed to help conduct your affairs? |
| NOTE: You must provide a copy of the declaration or appointment. |
| Provide a detailed explanation | ||
| References |
| Attorney References |
| Provide three (3) attorneys who know you. If you are not admitted to practice law, and you do not know three attorneys, substitute law school professors or other professionals. |
| Do not include yourself, any person related to you by blood or marriage or anyone who resides at your current residence or any individuals already referred to in your application as a verifying reference. |
| Years Known |
| Reference Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Country |
| Zip Code |
| Phone Number |
| Personal References |
| Provide six (6) references, preferably persons who have known you for at least five (5) years, including one person from EVERY location where you have lived or been employed during the last ten years or since admission to the bar of any other jurisdiction (whichever is longer) with whom you are personally acquainted. |
| Do not include yourself, any person related to you by blood or marriage or anyone who resides at your current residence or any individuals already referred to in your application as a verifying reference. |
| Years Known |
| Reference Name |
| Address 1 |
| Address 2 |
| City |
| State |
| Country |
| Zip Code |
| Phone Number |
| Self Disclosure |
| Self Disclosure |
| Is there any additional information with respect to possible misconduct or lack of moral qualifications on your part, which is not otherwise disclosed by your answers to questions in this application? |
| Detailed Explanation | ||
| NOTE: This is not meant to be used to supplement any information related to previously asked application questions. That information should be included in the detailed explanation related to the specific question or as an Application Amendment available once your application is submitted. |
| Acknowledgements |
| Acknowledgements |
| I verify and state that I am the applicant named in the foregoing application; that I respectfully apply to the Colorado Supreme Court through its Office of Attorney and LLP Admissions for admission to the Bar of the State of Colorado; that the statements and representations made in the foregoing application are true and correct; that these statements and representations are made for the purpose of inducing the Colorado Supreme Court to grant me a license to practice law; and I understand that if any statements or representations in this application are false or untrue, that the license may be denied or, if granted, may be revoked. |
| I confirm that all questions for all sections of my online application have been understood, answered and reviewed for completeness and truthfulness. I further confirm that I have not omitted any facts or matters pertinent to my application. |
| I confirm that I have provided a detailed explanation to any character and fitness question for which I answered “yes” and I will provide required supporting documentation to my application in a timely manner. |
| I confirm I have reviewed the Required Documents section of my User Homepage. All required forms, supplementary documents and court documents associated with my application have been, or will be, uploaded with my application in a timely manner. |
| I acknowledge my obligation to report all address and email changes within ten (10) days of occurrence. |
| I acknowledge that this is a continuing application, and that I have an obligation to keep my responses to the questions current, complete and correct by filing timely amendments until the date of my admission to the practice of law in Colorado. I understand that an amendment is considered timely when made no later than ten (10) days after any occurrence that would change, or render incomplete, any answer on my bar application. |
I understand that by continuing I am certifying that all answers provided in my application are complete and truthful to the best of my knowledge. Furthermore, I understand that any question that is incomplete or untruthful may result in the denial of my application and forfeiture of any fees paid. |