UNITED STATES DISTRICT COURT FOR THE
WESTERN DISTRICT OF TEXAS
WACO DIVISION
CRIMINAL JUSTICE ACT (CJA) PANEL
QUESTIONNAIRE AND APPLICATION
Please return to:
Attn: CJA Panel Committee
c/o U.S. District Clerk’s Office
800 Franklin Ave., Room 380
Waco, TX 76701
1. Name:
Office Address: Telephone Numbers:
Office:
Cell:
Fax:
SSN or TIN: E-mail:
Texas Bar Number, and date admitted:
Date Admitted to Western District of Texas:
Other jurisdiction(s) admitted to practice law, and date(s) of admission(s):
Law school, and date of degree:
Professional affiliations:
2. Please select the panel category, or categories, you would like to be considered for:
General Felony GYes GNo
Complex-Case GYes GNo
Appellate GYes GNo
Non-Capital Habeas GYes GNo
Auxiliary GYes GNo
Material Witness GYes GNo
3. Indicate your relevant court experience by providing approximate totals in the following
categories:
Criminal Jury Trials: Federal Court: State Court:
Criminal Bench Trials: Federal Court: State Court:
Pleas and Sentences: Federal Court: State Court:
Criminal Appeals: Federal Court: State Court:
Habeas/28 U.S.C. §2255 Hearings: Federal Court: State Court:
Other Relevant Court Hearings: Federal Court: State Court:
If you indicated any relevant court hearings, please briefly describe:
4. Indicate any other legal experience which qualifies you for membership on the panel(s) for
which you have applied (for example, experience in a prosecutor’s or public defender’s office,
service as a judicial law clerk, or areas in which you have received Texas Board of Legal
Specialization Certification):
5. List the names and phones numbers of three lawyers who know of your ability as a criminal
law attorney:
Name: Phone Number:
6. Have you ever been subject to, or are you currently the subject of a pending action for,
any of the following: disbarment, suspension, public reprimand, contempt, disciplinary action or
complaint by any state or federal court, or other disciplinary action by or before any bar
association and/or licensing agency? GYes GNo
If you answered yes, please provide an attachment describing the underlying circumstances in
detail.
7. Are you fluent in any language other than English to the extent that you can represent a
client who speaks only that language without an interpreter? GYes GNo
If so, please list language(s):
I HEREBY CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND
CORRECT:
SIGNATURE DATE
