Pro Bono Civil Panel Questionnaire and Application
United States District Court
Northern District of Texas
First Name:
Middle
Initial:
Last Name:
Firm Name (if any):
Street Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Fax Number:
E-Mail Address:
Law School:
Date Admitted to Texas Bar:
Date Admitted to N.D. Texas:
Attorney Bar Number:
Other federal district and appellate courts admitted to (and dates admitted):
Professional memberships and affiliations:
Indicate your
Civil Trial
experience by proving approximate totals in the following categories:
Federal Court
State Court
Jury Trials
Bench Trials
Court Hearings
Depositions
Briefly describe your trial experience in both federal and state court (including criminal trial work).
Please list the names and phone numbers of two judges and/or attorneys who know of your ability as a trial attorney:
Name:
Telephone Number:
How many appointments are you willing to accept per year?
Are you fluent in any foreign language(s)? If so, list:
Are you willing to take appointments based on your foreign language proficiency?
Have you already handled a case through this panel?
If so, when?
Are you currently working on it?
If you have completed work on the case, how was it resolved (jury trial, settlement, etc)?
I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT.
Signature
Date
Enter the code in the image above (letters are case sensitive). For a new image hit F5.