| General Information |
| Personal |
| First Name | John |
| Middle Name | Frederick |
| Last Name | Example |
| Suffix | Jr. |
| Social Security Number |
| *Furnishing your SSN is voluntary pursuant to the Federal Privacy Act of 1974. Your SSN will be kept confidential and used only to avoid errors of identity. |
| Contact Information |
| Home Phone | (812) 111-5100 |
| Cell Phone | (812) 111-5101 |
| Office Phone | (812) 111-5102 |
| Other Phone | (812) 121-5203 |
| E-mail Address | sample@email.com |
| Street Address Line 1 | 3855 Lake Clearwater Place |
| Street Address Line 2 | Apt. 222 |
| City | Sarasota |
| State | Florida |
| Zip/Postal Code | 90210 |
| Country | United States of America |
| Enrollment |
| Enrollment Information |
| Are you presently enrolled as a student at a law school accredited by the American Bar Association? |
| List law school |
| Have you completed legal studies amounting to one-half of the credits required for graduation with J.D. degree? |
| List number of credit hours completed |
| List the month/year when you expect to complete your J.D. degree. |
| While enrolled as a law student, have you been accused or found guilty of violating the honor code or any other code of conduct or ethical standards of the law school? |
| Provide the date. |
| Provide complete description of the allegations and the disposition. | ||
| Have you been denied registration as a law student or any other registration or application in any U.S. state, territory, or the District of Columbia on the basis of your character and fitness? |
| Provide complete description of the denial, including by which state it was issued and the status. You are not eligible for certification under Rule 13 unless and until the denial has been resolved in your favor. | ||
| List the name(s) and address(es) of the Missouri attorney(s) who will supervise your activities under Rule 13. |
| Attorney's Name |
| Firm or Organization: |
| Street Address or PO Box |
| City |
| State |
| Zip |
| Daytime telephone number |
| E-mail address |
| Do you pledge to abide by and comply with the provisions of Supreme Court Rule 13? |
| Do you pledge to abide by and comply with the provisions of Supreme Court Rule 4, Rules of Professional Conduct? |
| ATTESTATION |
| ATTESTATION |
| I understand that this Application is a continuing application and must state correctly and completely the information herein sought. No later than thirty (30) days after the happening of an event, I will file a written update to this application to notify the Board of Law Examiners as to any change in any respect to any information provided or sought in this application or as to any incident which may have any bearing upon any information sought. |
| I acknowledge that any false, misleading, evasive, or incomplete response in the foregoing application is inconsistent with the truthfulness and candor required of a practicing attorney and may be grounds for a finding that I lack the requisite character and fitness for admission to the bar in Missouri. |
| I hereby affirm under penalty of perjury that all statements contained in this application are true and complete. |
| I agree |