APPLICATION FOR INCLUSION ON DISTRICT & COUNTY COURT ATTORNEY APPOINTMENT LIST

Please complete all information requested. Please type or print.

Name: ______and I wish to be considered for appointments in Lamar County, Texas.

Business Mailing Address: ______

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Business Telephone Number: ______

Business Fax Number: ______

Email Address: ______

State Bar Number: ______

Month & Year licensed to practice law in Texas: ______

LawSchool Attended: ______Year Graduated: ______

Other Relevant Education: ______

Have you attended the Advanced Criminal law Course? Yes ______No ______

If yes, what year: ______

Have you had at least 8 CLE hours in criminal law in the last four (4) years?

Yes ______No ______Attach proof of CLE hours

Have you had at least 8 CLE hours in juvenile law in the last four (4) years?

Yes ______No ______Attach proof of CLE hours

Have you had at least 8 CLE hours in appellate criminal or juvenile law in last four (4) years?

Yes ______No ______Attach proof of CLE hours

Are you fluent in any language other than English? Yes ______No ______

If yes, what language? ______

Have you ever been sanctioned or reprimanded by the State Bar? Yes ______No ______

If yes, explain? ______

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Do you have any pending grievances? Yes ______No ______

If yes, explain?

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Please furnish the following:

I have had the following experience: (make your best estimate)

1.I have tried ______felony cases to completion with a jury.

2.I have plead ______felony cases.

3. I have tried ______capital cases to completion where defendant could have received a death sentence.

4. I have tried ______capital cases to completion where defendant was exposed only to a life sentence.

5.I have tried ______Class A & B misdemeanor cases to completion with a jury.

6. I have plead ______Class A & B misdemeanor cases.

7. I have defended ______civil contempt cases.

8. I have represented ______persons whose commitment was sought for mental problems.

9.I have served as attorney/guardian ad litem in ______civil cases.

10.I have represented ______parents whose parental rights were being terminated over their opposition.

11.I have represented ______juveniles in contested juvenile cases (either jury or non-jury).

I will be available for appointment and believe that I am properly qualified to represent clients in the following types of cases.

1.______capital cases with death exposure

2.______capital cases with exposure limited to life sentence

3.______1st degree felonies

4.______2nd degree felonies

5.______3rd degree felonies

6.______State Jail felonies

7.______Class A misdemeanors

8.______Class B. misdemeanors

9.______Appeals

10.______Juvenile proceedings

11.______Ad Litem mental commitments

12. ______Civil Ad Litem proceedings

13.______Parental rights terminations

A copy of the Amended Lamar County Plan and Standing Rules and Order Governing Procedures for Timely and Fair Appointment of Counsel for Indigent Accused Persons in LamarCounty (Amended 10-22-07) is attached and I have read and understand it.

By my signature below, I swear or affirm that the information I have provided in this application if true and correct.

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Signature

Subscribed and sworn to before me this ______day of ______, 20____.

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Notary Public, State of Texas