(Revised 12/11) 

United States District Court Northern District of Illinois

MOTION FOR LEAVE TO APPEAR PRO HAC VICE

Case Title: Plantiff(s)

VS.

Defendant(s)

Case Number: Judge:

I, hereby apply to the Court

under Local Rule 83.14 for permission to appear and participate in the above-entitled action on behalf of

by whom I have been retained.

I am a member in good standing and eligible to practice before the following courts:

Title of Court DateAdmitted

I have currently, or within the year preceding the date of this application, made pro hac vice applications to this

Court in the following actions:

Case Number Case Title

Date of Application

(Granted or Denied)*

*If denied, please explain:

(Attach additional form if

necessary)

Pursuant to Local Rule 83.15(a), applicants who do not have an office within the Northern District of Illinois must designate, at the

time of filing their initial notice or pleading, a member of the bar of this Court having an office within this District upon who service of

papers may be made.

Has the applicant designated local counsel? Yes No

If you have not designated local counsel, Local Rule 83.15(b) provides that the designation must be made within thirty (30) days.

Case: 1:11-cv-07972 Document #: 68 Filed: 05/02/13 Page 1 of 2 PageID #:414
Has the applicant ever been:

censured, suspended, disbarred, or otherwise disciplined by any court? Yes No

or is the applicant currently the subject of an investigation of the

applicant’s professional conduct? Yes No

transferred to inactive status, voluntarily withdrawn, or resigned from the

bar of any court? Yes No

denied admission to the bar of any court? Yes No

held in contempt of court? Yes No

NOTE: If the answer to any of the above questions is yes, please attach a brief description of the incident(s) and the applicant’s current

status before any court, or any agency thereof, where disciplinary sanctions were imposed, or where an investigation or investigations

of the applicant’s conduct may have been instituted.

I have read the Rules of Professional Conduct for the Northern District of Illinois and the Standards for Professional Conduct within

the Seventh Federal Judicial Circuit, and will faithfully adhere to them. I declare under penalty of perjury that the foregoing is true and

correct.

S/

Date Electronic Signature of Applicant

Applicant’s Name

Last Name First Name Middle Name/Initial

Applicant’s Law Firm

Applicant’s Address

Street Address Room/Suite Number 

City State ZIP Code Work Phone Number

(The pro hac vice admission fee is $100.00 for cases filed before February 1, 2001, and $50.00 for cases filed on or after that

date, and shall be paid to the Clerk. No admission under Rule 83.14 is effective until such time as the fee has been paid.)

NOTE: Attorneys seeking to appear pro hac vice may wish to consider filing a petition for admission to the general bar of this Court. The

fee for admission to the General Bar is $176.00 The fee for pro hac vice admission is $100.00 for cases filed before February 1,

2001, and $50.00 for cases filed after that date. Admission to the general bar permits an attorney to practice before this Court. 

Pro hac vice admission entitles an attorney to appear in a particular case only. Application for such admission must be made in

each case; and the admission fee must be paid in each case.

Case: 1:11-cv-07972 Document #: 68 Filed: 05/02/13 Page 2 of 2 PageID #:415