810 Application

Pursuant to Rule 8.10

Personal Information

Applicant's Name

John Smith

Social Security Number

***-**-****

Law School

List the law school from which you graduated and the date your J.D. degree was awarded:

Law School

Date J.D. degree awarded (month/year)

Bar Membership

A	List all U.S. states, territories, or the District of Columbia wherein you have been admitted to practice law during the preceding ten years and provide the official date of your admission:

Jurisdiction

Date Admitted

Inactive Status

In the preceding ten years, has your law license in any jurisdiction been on inactive status or have you been ineligible to practice in the jurisdiction for any reason?

If YES: Indicate the jurisdiction and the beginning and ending dates of all periods of inactive status or ineligibility:

Jurisdiction

Beginning Date

Ending Date

Previous Practice of Law

Teaching

In the preceding ten years, have you taught law full-time in ABA approved law schools while holding an active license to practice law in some U.S. state, territory, or D.C.?

If Yes, list the law school and the dates when you taught there:

Law School

Taught from Mo/Yr

To Mo/Yr

Federal or military practice

In the preceding ten years, have you served as a lawyer full-time with the United States government or its armed forces while holding an active license to practice law in some U.S. state, territory, or D.C.?

If Yes, list the federal agency or the branch of the armed forces and the dates of your service:

Branch of Military/Federal Agency

Service from Mo/Yr

To Mo/Yr

In-house practice

In the preceding ten years, have you practiced full-time as in-house counsel while holding an active license to practice law in some U.S. state, territory, or D.C.?

If Yes, list the location of your office and the dates you practiced at or from that location:

City

State

Practiced from Mo/Yr

To Mo/Yr

Practice with a firm or state agency

In the preceding ten years, have you been engaged full-time in the practice of law primarily at or from an office in some U.S. state (other than Missouri), territory, or D.C. while holding an active law license in that state?

If Yes, list the location of your office, the dates you practiced at or from that location, and indicate if you were self-employed:

City:

State:

Practiced from Mo/Yr

To Mo/Yr

Were you self-employed at this location?

Self-employed

Are you relying upon any period of practice as a self-employed attorney to demonstrate your eligibility for admission without examination under Rule 8.10?

If Yes, list two attorneys or judges who can verify the nature, location(s), and duration of your self-employed practice:

Name

Firm/Organization

Address

City

State

Zip/Postal Code

Telephone

Email Address

Authorization

All applications are confidential and we cannot discuss the status of your application without your authorization, including with a secretary, administrative assistant, or spouse who contacts us on your behalf. Do you want to designate with someone with whom you authorize us to discuss your application?

Provide the name and telephone number of the person and describe the relationship (e.g., assistant, spouse, friend, etc.)

Name of person

Telephone

Email Address

Relationship

Attestation

I understand this Application for Admission Without Examination is a continuing application and must state correctly and completely the information herein sought during the time said application is pending before the Board of Law Examiners. I incorporate into this application all statements made in the Application for Character and Fitness Report submitted concurrently herewith. No later than thirty (30) days after the happening of an event, I will file an update to this application to notify the Board of Law Examiners as to any change in respect to any information provided or sought in this application, or to any incident which may have any bearing upon any information sought. I affirm under penalty of perjury that all statements in this application are true and complete.

I agree