Please check one of the following:
1.
I am a member in good standing of the bar of the highest court(s) of the following state(s), possession(s), territory(ies),
commonwealth(s), or the District of Columbia:
Full Name of Court
State Bar No. (if applicable)
(Please use space on reverse side to list additional jurisdictions.)
I am not (or am - explain fully on reverse side) subject to any order of any court or administrative agency
disbarring, suspending, enjoining, restraining, or otherwise restricting me in the practice of law and the courts listed above
comprise all of the jurisdictions (other than federal courts) where I am licensed to practice law.
2.
I am an accredited representative of the following qualified non-profit religious, charitable, social service, or similar
organization established in the United States, so recognized by the Executive Office for Immigration Review pursuant
to 8 C.F.R. § 1292.2 (provide name of organization):
3.
I am a law student or law graduate, reputable individual, accredited official, or other person authorized to represent
individuals pursuant to 8 C.F.R. § 1292.1 (explain fully on reverse side).
I have read and understand the statements provided on the reverse side of this form that set forth the regulations and conditions
governing appearances and representation before the Immigration Court. I declare under penalty of perjury under the laws of the
United States of America that the foregoing is true and correct.
SIGNATURE OF ATTORNEY OR REPRESENTATIVE
EOIR ID# PHONE NUMBER (with area code) DATE (mm/dd/yy)
NAME OF ATTORNEY OR REPRESENTATIVE (type or print) ADDRESS
Check here if new address
U.S. Department of Justice
Executive Office for Immigration Review
Immigration Court
Notice of Entry of Appearance as Attorney or
Representative Before the Immigration Court
X
OMB#1125-0006
I hereby enter my appearance as attorney or representative for, and at the request of,
the following named person(s):
NAME:
(First)
(Middle Initial)
(