1. Please check one of the following: this is an application for Admission on Examination ___ or
Admission on Motion without Examination ___. Please see the General Instructions for
guidance on filing complete applications.
APPLICATION FOR ADMISSION TO PRACTICE
AS AN ATTORNEY AND COUNSELOR-AT-LAW IN THE
STATE OF NEW YORK1
APPLICATION FOR ADMISSION QUESTIONNAIRE
TO THE APPELLATE DIVISION OF THE SUPREME COURT OF
THE STATE OF NEW YORK:
The undersigned hereby applies for admission to practice as an attorney and counselor-at-law
in all courts of the State of New York, and in support of such application submits the following
sworn statement and the accompanying affidavits and other papers.
A. PERSONAL INFORMATION
1. (a) State name in full________________________________________________________
(First) (Middle) (Last)
(b) Have you ever used or been known by any other name? _________________________
If so, state in full each name (other than the name above given) which you have used or
by which you have at any time been known, the period of, and the reasons for, the use of each such
name; if change of name is by marriage, so state; if change of name was by court order, so state.
(c) Social Security number ___________________________________________________
2. State the following:
(a) Age, date, and place of birth _______________________________________________
(b) Are you a citizen of the United States?_______________________________________
If you are not a citizen of the United States, state your immigration status. _____________
3. Present residence (full mailing address).