Collaborating Counsel Network Form

CONTACT INFORMATION

Full Name

First NameLast Name

E-mail

Phone Number

Area CodePhone Number

Alternate Phone Number

Area CodePhone Number

Company

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

LEGAL TRAINING & EXPERIENCE

Law School

Year JD Conferred

Please list all State Bar Admission(s) and corresponding license number(s) - Example: CA #12345678

Please list Federal Bar Admission(s) - Example: United States Court of Appeals for the First Circuit

Affiliation with CCJ:

Please list Professional Organization & Bar Association Memberships - Example: Federalist Society, American Bar Association

Clerkships:

Position

Court

Judge

Dates

Additional information on Clerkships can be emailed to CCJ@Claremont.org.

Have you ever been convicted of a felony?

Have you ever received any form of discipline from a court or a lawyers disciplinary authority since you were first admitted to practice law?

Have you ever been denied admission or readmission to the bar of any court?

Are there disciplinary proceedings presently pending against you?

If you answered yes to any of the four preceding questions, please provide an explanatory statement on the nature of your actions via email to CCJ@Claremont.org.

COLLABORATING WITH CCJ

I am willing to consider helping your efforts by (check all that apply):

I am willing to consider collaborating with CCJ in cases involving (check all that apply):

I would NOT like to work on cases involving (check all that apply):

DISCLAIMER

Submitting this form does not enroll you with the Center for Constitutional Jurisprudence’s attorney network. You will receive separate notice following the Center’s review of your application. Please be aware that your affiliation with the Center for Constitutional Jurisprudence’s attorney network is at the sole discretion and determination of the Center for Constitutional Jurisprudence and may be denied or terminated for any reason at the sole discretion and determination of the Center for Constitutional Jurisprudence.

Your future involvement with any case undertaken by the Center for Constitutional Jurisprudence will be entirely at your discretion at the time the case assistance request is sent.

I agree to the above disclaimer