UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF FLORIDA
Application for Criminal Justice Act Panel Membership
Section 1—Contact Information
Name:
Business Contact Information
Firm Name:
Firm Address:
City/State/Zip:
Work Phone:
Work Cell:
Work Fax:
Work Email:
Personal Contact Information
Home Address:
City/State/Zip:
Home Phone:
Home Cell:
Home Email:
Section 2—Law School Education
Law School:
Graduation Date:
Application for Membership, CJA Panel Middle District of Florida
Revised April 29, 2021 Page 1 of 10
Section 3—Bar Admissions
List all courts (including state bar admissions, the Middle District of Florida, the Eleventh
Circuit, and the Supreme Court) in which you are presently admitted to practice, giving the
dates of admission in each instance.
State Bar ID Number Date of Admission
Court Date of Admission
Section 4—CJA Panel Preferences
Select each divisional panel to which you apply:
☐ Fort Myers
☐ Jacksonville
☐ Ocala
☐ Orlando
☐ Tampa
Are you an appellate-only lawyer? (Check “Yes” if you will accept ONLY an appeal.) If yes,
skip to Section 5 and complete Sections 5 through 15.
☐ Yes
☐ No
Are you willing to accept an appointment to appear before a “duty” magistrate judge?
☐ Yes
☐ No
If yes, can you appear in court within two hours of notification in each division to which you
apply?
☐ Yes
☐ No
If not, enter an explanation here.
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Revised April 29, 2021 Page 2 of 10
In which of the following categories of cases will you accept an appointment?
☐ 0–12 trial days
☐ 13 or more trial days
Are you willing to handle an appeal from a trial in which you were not trial counsel?
☐ Yes
☐ No
Are you willing to handle a habeas corpus case?
☐ Yes
☐ No
Are you willing to handle a death penalty habeas corpus case?
☐ Yes
☐ No
Section 5—Office Location and Waiver
Do you maintain a primary, satellite, or shared office in the Middle District of Florida?
☐ Yes
☐ No
If YES, enter address here
*If not, you must submit a waiver request for each divisional panel to which you apply. See
CJA Plan, Section 1.05(b).
Section 6—Continuing Legal Education (CLE)
List your CLE experience as a participant or as a lecturer in a criminal or trial advocacy
program within the last three years.
Within the last twelve months, have you attended and completed a live course, video-taped
course, or seminar on the Federal Sentencing Guidelines?
☐ Yes
☐ No
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Revised April 29, 2021 Page 3 of 10
If so, was the Federal Sentencing Guidelines course or seminar either sponsored by a local
Federal Bar Association or approved by the Federal Public Defender of the Middle District
of Florida?
☐ Yes
☐ No
Within the last twelve months, have you attended a CLE about federal court criminal practice
or have you reviewed an approved video presentation about Middle District of Florida
criminal practice (the video presentation is on file in each Federal Defender Office in the
district)?
☐ Yes
☐ No
Section 7—Legal and Trial Experience
*Attach to this application a current resume that includes, at a minimum, college, law school,
all post-law school employment, and two professional references.
Briefly describe the nature of your present practice:
State the number of cases you have tried to verdict, including the court in which they were
tried.
Describe your last three criminal trials, including the type of case, judge’s name, prosecutor’s
name, case number, and date of trial. (Attach additional sheet if necessary.)
Judge Prosecutor Client Name & Case Number Date of Trial
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Revised April 29, 2021 Page 4 of 10
List by name the federal judges before whom you have appeared for a criminal matter:
Have you had occasion to use or apply the Federal Sentencing Guidelines?
☐ Yes
☐ No
If so, describe.
If you are willing to represent clients in death penalty habeas corpus cases, describe your
relevant experience:
Have you participated as counsel of record, either as prosecutor or defense attorney, in at least
one criminal jury trial in any federal court?
☐ Yes
☐ No
If not, have you participated in a federal criminal jury trial by sitting “second chair” to a
member of a divisional CJA Mentor Panel?
☐ Yes
☐ No
*If you have participated as a “second chair” to a member of a divisional CJA Mentor Panel,
attach to this application a letter from the member verifying that you have completed the
mentor program.
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Revised April 29, 2021 Page 5 of 10
Section 8—Board Certification
List any area of law in which you are board-certified, including criminal trial, civil trial,
appellate, or other, and the state in which you are certified.
Section 9 – Research and Writing Experience
*Attach to this application a writing sample that has not been edited by others.
Have you ever been employed as a full-time prosecutor, public defender, or law clerk to a
judge or justice?
☐ Yes
☐ No
If yes, describe the position, the name of your employer, and the dates of employment.
Describe any specialized training or experience in the field of legal research or writing:
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Revised April 29, 2021 Page 6 of 10
Section 10—Prior CJA Experience
Have you in the past been a member of a CJA Panel for this Court?
☐ Yes
☐ No
List any other court’s CJA Panel of which you have previously been a member:
Court CJA Panel Dates
Have you ever been removed from or voluntarily resigned from this Court’s CJA Panel or
any other court-appointed attorney panel for disciplinary reasons?
☐ Yes
☐ No
If so, explain on a separate sheet.
Section 11—Appellate Experience
Approximately how many appellate briefs have you filed in the last five years? List each court
and the number of briefs.
How many oral arguments have you participated in over the last five years? List each court
and the number of OAs.
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Revised April 29, 2021 Page 7 of 10
Briefly describe your experience with federal habeas corpus proceedings:
Describe the most significant appellate matter you have handled including the case name and
number, whether oral argument was granted, and the disposition of the case.
Section 12—Other Skills and Experience
Briefly describe any other experience that bears on your qualification to serve as CJA counsel
(i.e., teaching, bar activities, writing).
List any language in which you are fluent:
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Revised April 29, 2021 Page 8 of 10
Section 13—Disciplinary Actions
Are you in good standing with this court’s bar, The Florida Bar, and if applicable, the Bar of
the Eleventh Circuit?
☐ Yes
☐ No
Have you ever been disciplined by a court, The Florida Bar, or any other state agency
regulating attorneys?
☐ Yes
☐ No
*If so, explain in detail on a separate sheet the nature of the discipline and the conduct that
led to the disciplinary action.
Are you the subject of any pending disciplinary action by the Bar of any jurisdiction or by a
court?
☐ Yes
☐ No
*If so, explain in detail on a separate sheet the nature of the pending disciplinary action.
Have you ever been found by a court to have provided constitutionally ineffective assistance
of counsel (irrespective of whether such ineffective assistance of counsel resulted in
prejudice to a defendant)?
☐ Yes
☐ No
*If so, explain in detail on a separate sheet the finding about constitutionally ineffective
assistance of counsel and the outcome of any appeal.
Has a court or judicial officer ever made an express written finding that you have been
untruthful or lacked candor to a court or judicial officer?
☐ Yes
☐ No
*If so, explain in detail on a separate sheet the finding and the outcome of any appeal.
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Revised April 29, 2021 Page 9 of 10
Section 14—Mentor Panel
Are you willing to serve a three-year term on a division’s Mentor Panel as a Mentor? See CJA
Plan, Section 1.07.
☐ Yes
☐ No
Section 15—Certification, Signature,
and Instructions for Submission
It is your responsibility to notify the Federal Public Defender, in writing, if any of the
above information changes.
I HEREBY CERTIFY that the information in this application is true and correct and
that I have carefully read the provisions of 18 U.S.C. § 3006A(d) and (e). I request that I be
considered for appointment to the panel for representation of defendants under the Plan
approved in accord with the Criminal Justice Act of 1964, as amended by the CJA Revision
of 1986.
Name
Signature
Date
If you have a question about this application, contact the Attorney Services Coordinator
at: (407) 835-5644. Attach all documentation before submitting the application:
Waiver (if applicable) – See Section 5
Current Resume – See Section 7
Mentor Program Letter (if applicable) – See Section 7
Writing Sample – See Section 9
Prior CJA Removal or Resignation (if applicable) – See Section 10
Discipline (if applicable) – See Section 13
Email your signed application to the following address:
[email protected]
Or mail your signed application to the following address:
Middle District of Florida
Attn: Attorney Services Coordinator
401 West Central Boulevard
Orlando, Florida 32801
Application for Membership, CJA Panel Middle District of Florida
Revised April 29, 2021 Page 10 of 10
