Declaration of Intention to Study Law

1. Personal Information

1.1 Identifying Information

Full name

John Smith

Date of birth

January 10, 1961

Driver's License/ID No/Passport No.

Issuing State

Place of birth

Michigan

Type your name as you would like it to appear on your law license

A law license may be issued only in the name shown on a valid, government-issued identification card, except that a given name may be omitted or represented by an initial if the Applicant so requests in writing. No license may be issued using an alias, assumed name, nickname, or abbreviation of a name.

1.2 Other Names

Have you ever been known by any other name or surname?

Full Name

Date From

Date To

	Explanation of Change

1.3 Contact Information

Address 1

3855 Lake Clearwater Place

Address 2

Apt. 222

City

Sarasota

State

Florida

Zip

90210

County

Marion

Country

United States of America

Home phone number

(812) 111-5100

Cell phone number

(812) 111-5101

Work phone number

(812) 111-5102

Email Address

sample@email.com

1.4 Emergency Contact

Provide the following information for someone who can reach you in case of emergency.

Full Name

Relationship to applicant

Phone number

1.5 Past Residences

List each city (including any in Texas), state, and/or foreign country where you have resided, worked, or attended school during the last 10 years. Do not answer N/A for this item.

Date From

Date To

City

State

Country

2. Educational Information

2.1 Law School Information

2.1.1

Indicate the Texas Law School from which you will receive or have received your J.D.

Name of Law School

From

Attended

Degree

Date Awarded

Email Address

Phone number

Note: If you attended law school within the last 5 years, provide a signed copy of the application (including all attachments, amendments, and updates) you filed with each law school you have attended.

2.2 Previous Law School Information

2.2

Have you attended any other law school?

Name of Law School

From

Attended

Email Address

Phone number

Was this for a study abroad program or other temporary attendance?

	Describe reason for your attendance or reason you no longer attended this school

	Describe reason for your attendance or reason you no longer attended this school

2.3 College or University Information

2.3	List all colleges or universities that you have attended, including junior colleges, community colleges, and any periods of study abroad, and indicate the degree, if any, that you received.

Name of College or University

Degree, if any (e.g. BS, BA, etc. If you did not receive a degree, enter "None".)

Address 1

Address 2

City

State

Zip

From

Attended

Email Address

Phone number

2.4 School Discipline

Have you ever been disciplined in any way for any matter by any college, university, law school, or other institution of higher learning, or by any professor, administrator, employee or entity representing any college, university, law school or other institution of higher learning, or have you been allowed to withdraw from such an institution to avoid such discipline, whether or not the record of such action was retained in your file?

(Discipline includes, without limitation, a letter or other written notice of reprimand or warning, suspension, expulsion, adjustment of grade, assignment of community service, any form of probation, requirement to attend additional classes or presentations, or any other adverse action).

(Entity includes, without limitation, residential facilities or other facilities owned or managed by a college, university, law school or other institution of higher learning.)

Provide name of school where discipline occurred

Date of discipline

	Description of discipline

Note: Upload copies of relevant documentation for this discipline.

2.5 LSAC Information

You must provide your Law School Admission Council’s (LSAC) Account Number. Your LSAC number is the letter L, followed by an 8-digit number (ex: L01010101). The link for the LSAC account number lookup is http://lsaclookup.lsac.org/lookup.aspx. If you have interacted with LSAC in any way, you have an LSAC account number. If you do not have an LSAC account number, you need to create an account by going to http://lsaclookup.lsac.org/lookup.aspx. This number is NOT the same as your NCBE Account Number.

Law School Admission Council (LSAC) Account Number:

Within the last 10 years, have you been the subject of a determination of misconduct or irregularity by the Law School Admission Council (LSAC)?

Provide date of determination

	Provide detailed description of the circumstances

Note: Upload copies of relevant documentation for this alleged misconduct or irregularity.

3. Other Professional or Occupational Licenses

3.1 Professional Applications

Within the last 10 years, have you applied for any professional or occupational license?

State

Type of License

Date that you applied

Was it granted?

	Why not?

Name of licensing authority

Name Under Which You Applied

3.2 Professional Licenses

Have you ever been licensed in any professional or occupational capacity?

State or other

State

Other

Type of License

Date that you applied

Date License granted

Date license expired or will expire

Name of licensing authority

Name Under Which You Were Licensed

License Number

3.3 Professional Grievances

Have there ever been any formal or informal charges, complaints, or grievances filed (regardless of the outcome) concerning your conduct as a member of any profession, licensed occupation, or as the holder of any public office?

Name of Investigating Authority

Name Under Which You Were Licensed

License Number

	Description of complaint

	Resolution of complaint

Note: Upload copies of relevant documentation.

3.4 Pending Professional Grievances

Are there now pending any formal or informal charges, complaints, or grievances concerning your conduct as a member of any profession, licensed occupation, or as the holder of any public office?

Name of Investigating Authority

Name Under Which You Were Licensed

License Number

	Description of complaint

	Resolution of complaint

Note: Upload copies of relevant documentation.

4. Employment

4.1 Non-Legal Employment

Beginning with your current or most recent employment, list all non-law-related employment (including self-employment, externships, paid and unpaid internships, clerkships, part-time employment, and temporary employment) you have held for any period of time since your 18th birthday or during the last 10 years, whichever is shorter. Do not list legal or law-related employment here—you will list legal and law-related employment in the next section.

Do you have non-legal employment to disclose?

Name of Employer

Address 1

Address 2

City

State

Zip

Country

Email Address of supervisor or person who can verify your employment

Do not provide your own email address, even if you are self-employed.

Telephone number

Name of supervisor or person who can verify employment

Do not provide your own name, even if you are self-employed.

Date Started

Date Ended

Position

	Reason For Leaving

Were you terminated, suspended, disciplined, or permitted to resign in lieu of termination suspension or discipline, from this employment?

	Explain

4.2 Legal Employment

Beginning with your current or most recent employment, list all Law-Related Employment (exlude all entries you entered for non-legal employment) you have held for any period of time since your 18th birthday or during the last ten(10) years, which ever is shorter.

Do you have legal employment to disclose?

Name of Employer

Address 1

Address 2

City

State

Zip

Country

Email Address of supervisor or person who can verify employment

Do not provide your own email address, even if you are self-employed.

Telephone number

Name of supervisor or person who can verify employment

Do not provide your own name, even if you are self-employed.

Date Started

Date Ended

Position

	Reason For Leaving

Were you terminated, suspended, disciplined, or permitted to resign in lieu of termination suspension or discipline, from this employment?

	Explain

5. Military Service

Military Service

Have you ever served in any of the armed forces of the United States?

Branch of Service

Start Date

End Date

Type of Discharge

	Explain the reasons for your discharge. If you are currently serving, list that in your explanation instead.

Are you separated from the Service?

Note: Upload a copy of your discharge document listing character of service.

Nature of Separation

Type of Discharge

Were any courts martial, Article 15 proceedings, or administrative discharge proceedings lodged against you during your period of service?

Note: Upload a copy of relevant documentation.

Charge

Nature of Proceedings

Disposition

6. Criminal History Information

6.1 Criminal History Question 1

NOTE: If you have ever been convicted of a felony, or have been placed on probation for a felony, with or without an adjudication of guilt, read Rule 4(d) carefully. You may be prohibited from filing this form.

NOTE: Expunged and Sealed Offenses: Matters expunged pursuant to Texas Code of Criminal Procedure Art. 55.02, or pursuant to another state’s statute with the same force and effect, need not be disclosed. While expunged or sealed offenses, arrests, tickets, or citations need not be disclosed, it is your responsibility to ensure the offense, arrest, ticket, or citation has, in fact, been expunged or sealed. It is recommended that you obtain a copy of the Court Order expunging or sealing the record in question. Failure to reveal an offense, arrest, ticket, or citation that is not in fact expunged or sealed, raises questions related to truthfulness in addition to questions regarding the offense itself.

NOTE: Orders of Non-Disclosure: Pursuant to the Govt. Code [552.142(b)], if you have criminal matters that are the subject of an order of non-disclosure you are not required to reveal those criminal matters on this form. However, a criminal matter that is the subject of an order of non-disclosure may become a character and fitness issue. Pursuant to the other sections of the Government Code [411.081(d), 411.081(i)(5), 411.083(b), 411.084(a), 411.087(a), and 411.100], the Texas Board of Law Examiners is entitled to access criminal history record information that is the subject of an order of non-disclosure. Therefore, if the Board of Law Examiners discovers a criminal matter that is the subject of an order of non-disclosure, even if you properly did not reveal that matter, the Board of Law Examiners may ask you to provide information about that criminal matter.

Arrest/offense reports: If any of the offenses you describe resulted from an arrest (as opposed to a citation or a ticket) that occurred within five years of the date you sign this Application, you are responsible for either providing legible copies of the arrest/offense reports for such offenses, or providing proof that you made a written request for such reports. You are not required to provide copies of citations or tickets.

Court records: If any of the offenses you describe, whether they resulted from an arrest, citation or ticket, occurred within five years of the date you sign this Application, you are responsible for either providing legible copies of all court records for all such offenses, or providing proof that you made a written request for such court records.

It is very important that you make your written requests to the correct agency or court.

Records required to be provided

6.1

Have you ever been convicted of an offense, placed on probation, or granted deferred adjudication or any type of pretrial diversion? You must report any such offenses involving alcohol or drugs. You must report any failure to appear conviction resulting from any offense. You must report any conviction for failure to maintain financial responsibility (legally required auto insurance). You may exclude only Class C misdemeanor traffic violations.

Date of Incident

Location of Incident

Arresting/Ticketing Agency

Address

City

State

Zip

Initial Charge(s)

Initial Type

Ultimate Charges

Ultimate Type

Plea

	Disposition (If probation, deferred adjudication, or deferred prosecution, give summary.)

Style/Cause Number

Title of Court

Address of Court

City

State

Zip

Were you represented by an attorney?

Legal Counsel

Address of Counsel

City

State

Zip

	Detailed description of events and circumstances leading to arrest, citation, or ticket and/or criminal charge.

Were there any allegations of Fraud?

	List specific allegations

	List outcome of allegations

6.2 Criminal History Question 2

6.2

Have you, within the last 10 years, been arrested, cited or ticketed for, or charged with any violation of the law? You must report any such offenses involving alcohol or drugs. You must report any failure to appear charge or warrant resulting from any such offense. You must report any failure to maintain financial responsibility (legally required auto insurance) arrest, citation, ticket or charge. You may exclude only Class C misdemeanor traffic violations.

Date of Incident

Location of Incident

Arresting/Ticketing Agency

Address

City

State

Zip

Initial Charge(s)

Initial Type

Ultimate Charges

Ultimate Type

Plea

	Disposition (If probation, deferred adjudication, or deferred prosecution, give summary.)

Style/Cause Number

Title of Court

Address of Court

City

State

Zip

Were you represented by an attorney?

Legal Counsel

Address of Counsel

City

State

Zip

	Detailed description of events and circumstances leading to arrest, citation, or ticket and/or criminal charge.

Were there any allegations of Fraud?

	List specific allegations

	List outcome of allegations

6.3 Criminal History Question 3

6.3

Are you currently the target or subject of a grand jury or other governmental agency investigation?

Name of Governmental body conducting inquiry

Address 1

Address 2

City

State

Zip

Country

Phone number

	Provide complete description of the subject of the inquiry and the current status of that inquiry

7. Fitness Information

7.1 Conduct or Behavior

Within the past 5 years, have you exhibited any conduct or behavior that could call into question your ability to practice law in a competent, ethical, professional, and civil manner?

Date(s)

From

	Description

7.2 Mitigation

The purpose of this inquiry is to determine the current fitness of an applicant to practice law. The mere fact of treatment, monitoring, or participation in a support group is not, in itself, a basis on which admission is denied; the Board of Law Examiners encourages applicants who may benefit from assistance to seek it.

Within the past 5 years, have you asserted any condition or impairment as a defense, in mitigation, or as an explanation for your conduct in the course of any inquiry, investigation, or administrative or judicial proceeding by an educational institution, governmental agency, professional organization, or licensing authority; or in connection with an unemployment claim, employer discipline, or termination procedure?

Name of entity

Dates of the proceeding

From

Address 1

Address 2

City

State

Zip

Telephone number

Email address

	Disposition (if any)

	Description of conduct at issue

	Defense or mitigation offered in response to the investigation or allegation

8. Civil Litigation

8.1 Civil Litigation

Within the last 10 years, have you been a party to any civil suit or proceeding?

Date the civil suit or proceeding began

Role

Other role

Note: If you are a defendant in a matter that is pending, provide a copy of the docket sheet and the most recent complaint or petition.

Note: If you are a defendant in a matter that has been concluded, provide a legible copy of the docket sheet. If a judgment was rendered against you, provide a legible copy of the judgment and proof of satisfaction, if applicable. Provide an explanation if the judgment has not been satisfied. If the matter resulted in a settlement, provide a summary of the terms as they relate to you and a statement as to whether you adhered to same.

Style

Cause Number(s)

Title of Court

Address of Court

City

State

Zip

Were you represented by an attorney?

Legal Counsel

Address 1

Address 2

City

State

Zip

Disposition

	Summary

Were there any allegations of fraud in this civil proceeding?

	Describe the allegations and the outcome if resolved.

Note: If you were accused of fraud, regardless of what party you were in a civil suit, provide a copy of the complaint or petition and documentation showing the resolution of the allegation, if not already provided.

8.2 Bankruptcy

Within the last 10 years, have you filed or been the subject of a petition in bankruptcy?

Note: Provide legible copies of the bankruptcy petition, all schedules, discharge order (if applicable), and other pleadings relevant to your responses. If you filed a Chapter 7 Petition that resulted in a discharge, include a statement as to whether any of your scheduled debts were not discharged.

Date of filing

Court of filing

Was bankruptcy discharged?

	Why not?

Were there any allegations of Fraud?

Note: Provide a copy of the documentation related to the allegations of fraud.

	List specific allegations

	List outcome of allegations

Were there any adversary proceedings initiated?

	Describe adversary proceeding

	List outcome of proceeding

Note: Provide a copy of the documentation related to the adversary proceedings.

8.3 Child Support Order

Have you ever been ordered by a court to pay child support?

If “yes” provide the contact information of the payee and agency (if applicable) to whom you submit/submitted payment.

Note: Provide copies of relevant documents including any pending court documents, court orders, and child support agreements incident to a divorce.

Date child support obligation began

Case number or account number

Name of payee

Address 1

Address 2

City

State

Zip

Telephone number

Email Address

Is child support paid to an agency?

Name of agency

Address 1

Address 2

City

State

Zip

Telephone number

Email Address

Are you still obligated to pay child support?

	If you are no longer required to pay child support, explain why not?

8.4 Child Support - Past Due

Are you now, or have you been within the last 10 years, past due in any such court-ordered child support payments?

Name of payee

Address 1

Address 2

City

State

Zip

Telephone number

Email Address

Date(s) of past due payments

From

Are payments now current?

	Explain why not and when expected to be current?

8.5 Child Support - Arrearage Judgment

Have you ever had an arrearage judgment taken against you?

Date of Arrearage Judgement

Arrearage amount

Title of Court

Address 1

Address 2

City

State

Zip

Telephone number

Email Address

Are payments now current?

	Explain why not and when you expect to be current.

8.6 Contempt of Court

Have you ever been held in contempt of court or sanctioned by a court?

Date of contempt or sanction

Name of the court

Address 1

Address 2

City

State

Zip

Telephone number

Email Address

	Detailed explanation of events leading to the contempt or sanction

Note: Provide copy of court order or judgment and proof of satisfaction (if applicable).

9. Legal and Financial Responsibility

9.1 Debts

Do you have any debts that are 90 days or more past due?

	Reason for the delinquency

	Steps being taken to resolve the delinquency

Note: Provide a current credit report from EXPERIAN (1-888-397-3742 or www.experian.com) When you provide a credit report, list any debts you dispute and explain why you dispute them.

9.2 Tax Return Filing Issues

Within the past 10 years, have you failed to timely file any applicable state or federal income tax return and/or report required by law? (Timely filing pursuant to an approved extension is not considered failure to timely file a return.)

Type of tax return not timely filed (1040, 940, 941, etc.)

Date of return not timely filed

Name of taxing authority

Has return been filed?

Date return filed

	Why not?

Note: Federal taxes: order Tax Account Transcripts for the relevant year(s) from the IRS (https://www.irs.gov/individuals/get-transcript) and upload them to your account. Ensure you request Tax Account Transcripts.
State taxes: Request a statement confirming that you have filed all required tax returns, and verifying your balance, if any, from the relevant state taxing authority and upload it to your account.

9.3 Tax Payment Issues

Within the last 10 years, have you failed to pay any taxes owed pursuant to state or federal law at the time such taxes were due?

Type of tax not timely paid (1040, 940, 941, etc.)

Date of return not timely paid

Name of taxing authority

Amount owed

Has tax been paid?

Date paid

	Why not?

9.4 Withholding Tax Issues

Within the last 10 years, have you collected federal withholding, social security, or Medicare taxes from the wages of your employees, and failed to timely report and forward such monies to the Internal Revenue Service?

Type of withholding not reported and forwarded to IRS

Date

Amount that should have been reported and forwarded

Has amount been reported and forwarded to IRS?

Date Paid

	Why not?

Note: Federal taxes: order Tax Account Transcripts for the relevant year(s) or quarter(s) from the IRS (https://www.irs.gov/individuals/get-transcript) and upload them to your account. Ensure you request Tax Account Transcripts.
State taxes: Request a statement confirming that you have filed all required tax returns, and verifying your balance, if any, from the relevant state taxing authority and upload it to your account.

9.5 UPL

Within the last 10 years, have you been the subject of an investigation for the unauthorized practice of law in Texas or any other jurisdiction?

Date of investigation

Name of entity investigating

	Outcome of investigation

	Description of circumstances

Note: Upload copies of relevant documentation.

9.6 Oath

Are you willing to take the oath required of attorneys in Texas?

	If not, explain fully the reason you will not execute the required oath of office.

10. Requirements

Rule 2(a)(5) Requirements

Are you presently a United States citizen or National?

You must upload a birth certificate issued by a U.S. city, county, or state, an original Consular Report of Birth, a Certificate of Naturalization, or a Certificate of Citizenship.

Are you presently an alien lawfully admitted to the U.S. for permanent residence, or are you presently otherwise authorized to work lawfully in the U.S.?

You must upload the USCIS document evidencing your status.

Are you presently residing outside the U.S.?

You must upload a valid identification card, containing the address where you reside, issued by a governmental body in the jurisdiction in which you reside. In addition, you must execute the Statement of Residency Outside the United States.

To be eligible for admission as a licensed attorney in Texas, you must qualify under one of the categories set out in Rule 2(a)(5).

11. References

Character References

List six(6) character references who can give information about your past activities and candid opinions concerning your character. Do not list relatives, persons with whom you attended law school in the past 5 years, or any person named in your response to Questions 4.1 or 4.2.

Name

Email address

Phone number

Address 1

Address 2

City

State

Zip

12. Certification

Certification

I have read the instructions and inquiries that constitute the Declaration of Intention to Study Law. I have responded to all inquiries on this form fully and frankly, and all the information contained in my Declaration and related documents is true and correct. All documents that I have proved or will provide to the Board that are not required to be certified copies are to the best of my knowledge true and correct copies of the original documents.

I understand that the purpose of all of the inquiries in this Declaration is to provide to the Board of Law Examiners sufficient information for its investigation as to my present moral character and fitness. I understand that failure to respond to any inquiry or to disclose fully and accurately any facts of information called for herein may result in a finding that I do not have the present good moral character and/or fitness required for admission to the Bar of Texas.

I have read the current version of the Rules Governing Admission to the Bar of Texas and the statutes governing the Board of Law Examiners found in Texas Government Code §82.001 et seq. I understand that, until I am licensed to practice law in the State of Texas, it is my responsibility to read any subsequent amendments to the Rules Governing Admission to the Bar of Texas and to Texas Government Code §82.001 et seq., regardless of whether such amendments are adopted after the filing of this document.

I am aware that I am under an on-going obligation to update my responses on my Declaration whenever there is an addition or change to information previously provided to the Board, including mailing address, email address, and telephone number. I will notify the Board, in writing, as soon as practicable, of the occurrence giving rise to the need to add or to change information previously provided and will promptly furnish any additional documentation requested by the Board in connection therewith.

I understand that it is an offense to knowingly make a false entry in a government record. Tex. Penal Code §37.10.

I affirm the above.