Fill - Free fillable Board of Law Examiners (Kansas Judicial Branch) PDF form

Board of Law Examiners

Kansas Judicial Center, Room 374, 301 S.W. 10th Avenue, Topeka, Kansas 66612

To: Applicants for the Bar Examination in Kansas

Check to make sure you have the current application packet. Then review the application packet,

noting the application deadline. It is, of course, desirable to file in advance of the deadline. Any applicant

who wishes to file a completed application for admission after the filing deadline, but on or before November

1 (for the February examination) and on or before April 1 (for the July examination), must pay a late penalty

fee in the amount of $200 in addition to the application fee. Only complete applications will be accepted.

See Supreme Court Rule 713.

Kansas requires that your undergraduate and law transcripts be mailed directly to the Board from

the college or university. E-transcripts will not be accepted. Request final transcripts far enough in advance

that they are received by the Board no later than January 15 for the February examination and June 15 for

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the July examination. See Supreme Court Rule 706.

If you are admitted to practice in another state, you must obtain a certificate of good standing, a

disciplinary authority certificate, and a continuing legal education certificate from each state in which you

are admitted. Certificates of good standing are usually issued by the Clerk of the Supreme Court, and the

disciplinary authority certificate by the appropriate disciplinary governing board. Certificates of continuing

legal education should be obtained from the entity responsible for monitoring compliance in that state.

Continuing legal education certificates must include proof of compliance with both fee payments and

required hours. Certificates of good standing, disciplinary authority certificates, and continuing legal

education certificates will not be accepted by the Board if they are more than 90 days old at the time the

application is accepted by the Board.

All applicants for the Kansas Bar are required to submit a completed fingerprint card and the

required waivers as a part of the character and fitness investigation. Fingerprint card packets are available

through this office. If you have not done so already, you should complete the fingerprint packet and have

it submitted to this office immediately. Your application will not be accepted until the completed fingerprint

packet is received. No applicant for admission to the bar will be permitted to take the bar examination until

the application has been considered and approved by the Board.

If you are transferring an MBE score earned within thirteen months of the current examination and

you successfully passed the entire bar examination in the other jurisdiction in one sitting, you must contact

the state from which the score is being transferred to determine their procedure for transferring the score to

Kansas. This score must be received no later than January 15 for the February examination and June 15

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for the July examination if the score is to be used. Failure to timely submit an MBE score will reults in the

applicant sitting for both days of the examination.

All applicants must obtain a minimum scaled score of 80 on the MPRE to be admitted in Kansas.

If you previously took the MPRE and have submitted a score less than 80 or have not yet taken the MPRE,

it is strongly recommended you make arrangements to do so immediately.

You will be advised in writing at the time your application is accepted if your transcripts, MPRE

score, or MBE score are not on file at the time of filing. This will be your only notice. Failure to submit

items by the stated deadlines will result in your removal without further warning.

Kansas Board of Law Examiners

KANSAS

APPLICATION FOR ADMISSION TO THE BAR OF THE STATE OF

KANSAS

BY

WRITTEN EXAMINATION

IMPORTANT

Commensurate with what Kansas expects of its’ practicing attorneys, it is the

applicant’s responsibility to ensure that all necessary material is included with

your application. Failure to do so will result in the return of your application. See

Rule 713.

Examination dates: The last Tuesday and Wednesday of February & July

Filing fees and deadlines: $700

Application must be received by:

• October 1 for a February examination

st

• March 1 for a July examination

st

Completed Applications received after the filing deadline, but on or

before November 1 (for February examinations)and on or before

st

April 1st (for July examinations), shall pay a late penalty fee in the

amount of $200 in addition to the application fee.

Checks payable to: Clerk of the Supreme Court

Address for filing applications:

KANSAS BOARD OF LAW EXAMINERS

KANSAS JUDICIAL CENTER, ROOM 374

301 SW 10TH AVENUE

TOPEKA, KS 66612-1507

(Applications may be delivered in person; however,

your application will be reviewed in the order it was received.

In the event that your application is incomplete, it will be returned

to you by first class mail.)

Telephone No.: (785) 296-8410

E-mail: admissions@kscourts.org

READ THE FOLLOWING BEFORE YOU BEGIN

1. Read the entire application carefully before making entries.

2. Entries must be typewritten or the application completed on-line using

Adobe.

3. You will need to obtain an NCBE number to complete this application. If

you do not already have an NCBE number, you may register for one at

http://www.ncbex.org under the link “Get an NCBE Number.”

4. Answer all questions within the application, following the instructions for

each question exactly. Every question requires an answer.

5. Use your full legal name - no initials.

6. Avoid abbreviations.

7. When supplementing answers, be complete. If additional space is needed

for your answer, attach an additional page of explanation immediately

following the page on which the question occurs.

8. When additional documentation is required, attach the necessary documents

immediately following the page on which the question occurs.

9. Original signatures are required on several pages throughout the application.

All signatures, with the exception of the photo identification sheet, must be

notarized. Always sign in BLUE INK.

10. All lines on the notary certificate must be completed, including the State

and County. All signatures must be completed in BLUE INK. A complete

notary certificate must include a seal or notary stamp.

10. Submit your completed application in order. Remember to attached

required supplemental documents immediately following the page with the

question the document pertains to.

11. Include the required filing fee. Checks should be made payable to: Clerk of

the Supreme Court.

12. Submit one original completed application and one exact copy of the

completed application including all required supplemental material.

Incomplete applications will be returned and not considered filed. It is

the applicant’s responsibility to ensure that all necessary material is

attached to the application.

13. Make and keep a copy of your application for your records.

14. Obtain and complete a Kansas Bar Examination Fingerprint Packet to

submit with your completed application. Fingerprint packets are available

through this office. To obtain a fingerprint packet complete the form on the

website or contact the Board.

15. DO NOT call the Board to ask whether your application has been received.

Mail “certified” or other trackable method if you need confirmation.

16. Keep the Board advised of any change that occurs after the filing of your

application. As stated in the continuing obligation oath, you are required to

notify the Board in writing within 5 days of any event which would change

your response to any question on the application. This obligation continues

until you are sworn-in to the bar.

17. Reread the instructions and check the Board’s web page for bar applicants

before calling with questions. If you do not locate the answer, please

contact the Board by e-mail at admissions@kscourts.org, or by phone at

(785) 296-8410.

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APPLICATION FOR ADMISSION TO THE Docket No. ______________

BAR OF THE STATE OF KANSAS (KBLE will assign)

BY WRITTEN EXAMINATION

IN RE: APPLICATION OF

____________________________________________

(Full Legal Name)

TO THE SUPREME COURT:

IN ACCORDANCE WITH THE RULES RELATING TO THE ADMISSION OF

ATTORNEYS, I, , HEREBY

(Full Legal Name)

FILE THE FOLLOWING APPLICATION IN THE SUPREME COURT OF THE STATE

OF KANSAS FOR PERMISSION TO TAKE AN EXAMINATION CONDUCTED BY THE

KANSAS BOARD OF LAW EXAMINERS AND, UPON SUCCESSFUL COMPLETION

THEREOF, FOR ADMISSION TO PRACTICE LAW IN ALL COURTS OF THE STATE

OF KANSAS. TO EVIDENCE MY QUALIFICATIONS TO TAKE SUCH EXAMINATION,

I SHOW THE FOLLOWING:

1. Full Legal name

2. List all other names you have been known by. Include the dates you were known by these

names and the reason for the name change. If the name change was by court order, attach a copy

of the order immediately following this page.

3. Present address. If your physical address is different from your mailing address, you must list

both addresses, indicating which is the mailing address. Be sure to include apartment numbers

and the county in all addresses.

4. Home or cellular telephone number Work telephone number

5. NCBE Number

6. E-mail address (do not list e-mail addresses maintained by educational institutions)

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7. Date of birth

8. City and State of birth

9. Sex

10. Social Security Number

11. Height

12. Weight

13. Color of Eyes

14. Color of Hair

15. Have you ever served in the Armed Forces of the United States or any other country?

__ Yes __ No

If “yes,”provide a statement giving branch, dates of service, character of discharge,

and details in the space below. If discharge was other than honorable, include a copy

of your discharge papers.

16. Spouse’s name, if applicable, and address if different from applicant’s:

17. Parents’ names, mailing address, and telephone number:

18. If you do not have a spouse and both parents are deceased, list your next of kin. Include:

name, mailing address, telephone number, and relationship to the applicant.

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19. Driver’s License Number:

State Issued:

Expiration Date:

ATTACH A COPY OF YOUR CURRENT DRIVER’S LICENSE (FRONT AND BACK) IN

THE SPACE PROVIDED BELOW. If you do not have a driver’s license, state the reason why

on a separate sheet immediately following this page and attach a copy of a state-issued Identification

Card below. If your license is or has been restricted for any reason other than eye glasses or contacts,

attach your explanation on a separate sheet immediately following this page.

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20. Are you a citizen of the United States? __ Yes __ No

If claiming citizenship, other than by birth, state date naturalized, court and location, and

naturalization number.

If not a United States citizen, from what country do you claim citizenship?

If not a United States citizen, describe your immigration status and provide your alien

registration number and a copy of your resident alien card in the space below. If you do

not have an alien registration number or resident alien card, explain in the space below.

If you are not a United States citizen and do not have a resident alien card, provide a statement

explaining your legal status in the space below. You will also need to attach, immediately

following this page, legal documentation showing by what means you are in the country legally.

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21. List each residence address (including your present address) you have had for the past ten

years, starting with the most recent. List only the month and year of residence. There

should be no gaps in time. The following is an example of how a listing should look:

1234 A Avenue, Town, Kansas 66666 August 2003 - present

7546 West 15 Street, City, Kansas 67777 April 2001 - July 2003

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IF YOU NEED MORE SPACE THAN WHAT IS PROVIDED, ATTACH A SEPARATE

SHEET IMMEDIATELY FOLLOWING THIS PAGE.

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22. Are you currently employed? __ Yes __ No

In the space below, state name of employer, current address of employer, position held, dates of

employment and reason for termination of employment for the past ten years, starting with the

most recent. In the event the business is no longer in existence, list the last known address and

indicate that the business is no longer in existence.

Include periods of unemployment. There should be NO GAPS in time. For the purpose of

completing this section, use only month and year when listing the dates of employment. Sample

entries follow:

ABC Manufacturing, 55567 Law Street, City Town, KS 66666

Laborer, August 2002 - Present, still employed

ZXY Communications, 88879 College, City Town, KS 66666

Salesman, July 2001 - August 2002, found a better job

IF YOU NEED MORE SPACE THAN WHAT IS PROVIDED, ATTACH A SEPARATE

SHEET IMMEDIATELY FOLLOWING THIS PAGE.

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Supreme Court Rule 706 requires proof that an applicant has been granted and holds the requisite

undergraduate and JD degrees. Official transcripts issued by the registrar or equivalent officer of

each institution granting such degrees, and sent directly from such office to the Board will provide

sufficient proof of said degrees. Transcripts submitted by the applicant will not be accepted.

E transcripts will also not be accepted. Please read Supreme Court Rule 706 if you have questions

about educational eligibility.

Both transcripts must be received by January 15 for the February examination and by June 15 for

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the July examination. If you are unable to meet this deadline, you must contact the Board for further

instructions. Only final transcripts showing that the degree has been conferred will be accepted.

23. Provide the name of the school from which you received your undergraduate degree, the full

address for the school, and the date your degree was conferred.

24. Provide the name of the school from which you received your juris doctor or bachelor of

laws degree, the full address for the school, and the date your degree was conferred. If you have

not yet graduated, list your expected date of graduation. Attach, immediately following this

page, a copy of your law school application, including any amendments made to your

application after admission.

25. List all other colleges or universities (including law schools) which you have attended, dates

of attendance, degrees received (if any), and date of graduation if applicable. DO NOT

REQUEST TRANSCRIPTS FROM SCHOOLS ATTENDED WHERE A DEGREE WAS

NOT EARNED.

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26. Have you ever been dropped, suspended, placed on scholastic or disciplinary

probation, expelled or been requested to resign from any school, college or

university, or otherwise subjected to discipline by any school or institution or

requested or advised by any such school or institution to discontinue your studies there for

reasons other than failure to maintain a minimum GPA? __ Yes __ No

If you answered “yes,” provide a personal statement in the space below which includes:

details of each accusation, its disposition, and the punishment imposed, if any. You will

need to obtain a complete copy of the school, college, or university’s file regarding this

incident and attach it immediately following this page.

27. Despite whether the record has been expunged, canceled or annulled, or whether no

record was made, have you ever been accused of personal or academic dishonesty at

any school you attended or have you ever been subject to proceedings before a

school honor court, honor council, or similar body? __ Yes __ No

If you answered “yes,” provide a personal statement in the space below which includes:

details of each accusation, its disposition, and the punishment imposed, if any. You will

need to obtain a complete copy of the school’s file and attach it immediately following

your personal statement. If the school no longer has record of the incident, a written

letter from the school may be substituted for a copy of the file.

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28. Have you ever previously made application to take the Kansas bar examination?

__ Yes __ No

If “yes,” please indicate in the space below the date(s) of the examination(s) for which you

previously applied, whether you took the examination, if you did not take the examination why

you did not take the examination, or if you failed the examination.

29. Have you ever applied for a Kansas legal intern permit pursuant to Supreme Court Rule 719,

or a Kansas limited license pursuant to Supreme Court Rule 712? __ Yes __ No

If “yes,” please provide the date(s) of the application(s), whether you received the permit or

license, and if you received the permit or license the current status of the permit or license.

30. Have you ever made application to take the bar examination in a state other than Kansas?

__ Yes __ No

If “yes,” give the name of the state and the date(s) of the examination(s) for which you

previously applied. State the outcome of each application. For example: passed but not

admitted, passed and admitted, failed, withdrew, denied for character and fitness, etc.

If you were denied permission to take the examination for any reason, please list the reason

for the denial. If denied, you must contact the jurisdiction in which the denial took place and

request a certified copy of that bar application. That application must be submitted with this

application in order for this application to be considered complete.

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31. Have you ever been the subject of a formal proceeding or requested to appear in person

before a board of law examiners, or a representative of the board, in connection with an

application filed on your behalf in any other state? __ Yes __ No

If “yes,” please list the reason the proceeding was requested, the outcome of the proceeding,

and the decision made by the board or representative of the board. You must include a

certified copy of the application filed in that jurisdiction and a certified copy of the transcript

from the proceeding if a record was made. If the transcript from the proceeding was not

transcribed, you will need to contact the court reporter directly to obtain the transcript.

32. Have you ever applied for admission to practice law, other than by examination, in a state

other than Kansas? __ Yes __ No

If “yes,” please provide the name of the state, the date(s) of the application, whether you were

admitted to practice law, and if you were not admitted to practice law the reason your

application was denied or withdrawn.

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33. Are you admitted in another jurisdiction or state? __ Yes __ No

The list must include the date admitted and the status of the license for each jurisdiction.

If your license is “inactive,” please include the reason.

Immediately following this page, attach an original certificate of good standing,

original disciplinary authority certificate, and proof of compliance with continuing

legal education requirements for each state admitted. CLE certificates should reflect

present and past compliance. Only certificates issued within 90 days of the filing of

this application will be accepted.

34. Have you take the Multistate Professional Responsibility Examination (MPRE)?

__ Yes __ No

If “yes”, provide the date(s) of the examination(s) and your score(s) for the examination(s).

If “no”, provide the date you will sit for the MPRE. Make sure that you have made the proper

arrangements to have your score sent to Kansas in a timely manner. Only applicants with a

passing score on file with the Board are eligible to sit for examination in Kansas.

35. Do you wish to complete the essay portion of the UBE with the use of a laptop computer.

__ Yes __ No

By selecting “yes” you are agreeing to provide a laptop which meets the specifications required

by the Board’s third party vendor. The Board and the vendor accept no responsibility for any

malfunction of the laptop computer during the examination. It is your responsibility to ensure

the laptop is in working order on examination day. You will be emailed instructions from

Attorney Admissions on when and how to download the testing software. Failure to complete

all of the instructions contained in the email, including downloading the program by the stated

date will result in your removal from the laptop program and you be required to handwrite the

written portion of the examination.

36. Will you be transferring a Multistate Bar Examination (MBE) Score to Kansas?

__ Yes __ No

If “yes,” provide the name of the jurisdiction where you took the MBE, the date you took

the MBE, whether you passed the entire bar examination in such jurisdiction, and the date

you requested to have your MBE score reported to the Board, if you intend to transfer that

score. All scores must be received by January 15 for the February examination and by

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June 15 for the July examination and must be issued by NCBE or the jurisdiction where

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the score was received. See Supreme Court Rule 709(m).

37. Do you have a physical disability or impairment which requires testing accommodations

for taking the bar examination? __ Yes __ No

If testing accommodations are requested, the Board will need further information. It is

the applicant’s responsibility to obtain an Application for Testing Accommodations

which must be submitted in addition to this application. The Application for Testing

Accommodations must be filed with the Board on or before November 15 for the

February examination and on or before April 15 for the July examination. The

Application for Testing Accommodations is available on the Board’s web site.

38. Have you ever been a party to an action in divorce? __ Yes __ No

If “yes,” provide the name and address of the court of jurisdiction for each case on a separate

sheet of paper. Attach a copy of each settlement agreement, divorce decree, and journal entry

immediately following this page. If you were under a court-ordered obligation to pay alimony,

maintenance, or child support, provide a detailed explanation regarding the status of each

obligation immediately following this page. If you are delinquent on a court-ordered

obligation, provide the reason for the delinquency, documentation from the court showing the

amount past due, and a detailed financial plan to bring the obligation current.

39. Have you ever been a party to a civil law suit, other than an action in bankruptcy or divorce?

__ Yes __ No

If “yes,” provide the caption of the civil case, the name of the court of jurisdiction, the

address of the court of jurisdiction, the case number, and a brief description of the allegations

contained in each petition or complaint immediately following this page for each suit. List

each suit on a separate of paper and attach a copy of the petition or complaint, the dismissal

or judgment, and if you were the defendant a copy of the satisfaction of judgment for each suit.

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The purpose of the following inquiries is to determine the current fitness of the applicant to practice

law. The mere fact of treatment for mental health problems or addictions is not, in itself, a basis on

which an applicant is ordinarily denied admission, and the Board of Law Examiners routinely

certifies for admission individuals who have demonstrated personal responsibility and maturity in

dealing with mental health and addiction issues.

The Board of Law Examiners does, on occasion, deny certification to applicants whose ability to

function is impaired in a manner relevant to the practice of law at the time the licensing decision is

made, or to applicants who demonstrate a lack of candor by their responses. This is consistent with

the public purpose that underlies the licensing responsibilities assigned to bar admission agencies;

further, the responsibility for demonstrating qualification to practice law is ordinarily assigned to the

applicant.

The Board of Law Examiners does not, by its questions, seek information that is fairly characterized

as situational counseling. Examples of situational counseling include stress counseling, domestic

counseling, grief counseling, and counseling for eating or sleeping disorders. Generally, the Board

of Law Examiners does not view these types of counseling as germane to the issue of whether an

applicant is qualified to practice law.

40. Do you currently have any condition or impairment (including, but not limited to, substance

abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition) which in any

way affects your ability to practice law in a competent and professional manner?

__ Yes __ No

If you answer “yes” to question 40, please identify the condition or impairment, state when you

first discovered the condition or impairment, and describe how it currently affects your ability

to practice law.

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41. At the present time, does your personal debt exceed $150,000, excluding real estate loans?

__ Yes __ No

If “yes,” in the space provided below, provide the name of creditor, the address of creditor,

the account number, the nature of debt, the monthly payment, the current balance, and the

status of account. PERSONAL DEBT INCLUDES ALL STUDENT LOANS,

REGARDLESS OF THE STATUS OF THE LOAN(S).

42. Do you have any debts, including student loans, which are presently past due or which have

been placed in collection? __ Yes __ No

If “yes,” in the space provided below, provide the name of the creditor, the address of the

creditor, the account number, the nature of the debt, the monthly payment, the current balance,

the status of the account, and the reason the account is past due. You must also include a

reasonable detailed payment plan which works in your current budget to bring the account(s)

current.

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43. Have you ever had a credit card revoked? __ Yes __ No

If “yes,” in the space provided below, provide the name of the credit card company, the address

of the credit card company, the account number, the current balance on the credit card if any,

the reason the credit card was revoked, the terms of any agreement regarding the payment of

the balance of the credit card, and the current status of such agreement. If additional space is

needed, attach your statement immediately following this page.

44. Has a creditor ever filed suit against you? __ Yes __ No

If “yes,” in the space provided below, provide the name of the creditor, the address of the

creditor, the caption of the civil case, the name of the court of jurisdiction, the address of the

court of jurisdiction, the case number, the amount of the original judgment if any, the current

amount of the judgment if any, the terms of any agreement to pay the judgment, and the current

status of such an agreement for each suit. Remember to provide information for only one suit

per page. Attach a copy of the petition or complaint, a copy of the judgment, and a copy of the

satisfaction of judgment.

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45. Have you ever been a party to bankruptcy proceedings? __ Yes __ No

If “yes,” provide the amount of each debt discharged in bankruptcy, including the name of the

creditor, the address of the creditor, the date(s) each debt was incurred, and the nature of each

debt on a separate sheet immediately following this page. Additionally, provide your annual

income the year you filed for bankruptcy, your annual income the year immediately preceding

the bankruptcy filing, and your annual income the year immediately following the bankruptcy

filing. You must attach a copy of all bankruptcy pleadings, including the petition, the

statement of financial affairs, the schedules, any adversary proceedings, and the dismissal or

the discharge order immediately following this page.

46. Have you, within the last ten (10) years, failed to timely file any applicable local, state, or

federal income tax return, schedule, or report required by law? __ Yes __ No

If “yes,” provide the name and address of the taxing authority, the tax year(s) for which you

failed to file the return, schedule, or report, and the date you finally filed the return, schedule,

or report. Provide a factual statement explaining the reason(s) the taxes were not timely filed.

You must attach a copy of all returns, schedules, or reports referenced in this question

immediately following this page.

47. Have you, within the last ten (10) years, failed to timely pay any taxes owed pursuant to

state or federal law? __ Yes __ No

If “yes,” provide the name and address of the taxing authority, the tax year(s) for which you

failed to pay, and the date you finally paid the taxes. If you continue to owe past due taxes, list

the current balance of the taxes by tax year and by taxing authority. You must attach a copy

of all tax returns, schedules, and reports. Additionally, obtain and attach a copy of a current

tax statement from each taxing authority regarding each year you failed to pay your taxes. All

documentation must immediately follow this page.

48. Have you, within the last ten (10) years, collected federal withholding, social security, or

medicare taxes from the wages of your employees and failed to timely forward such monies

to the Internal Revenue Service? __ Yes __ No

If “yes,” provide the details below.

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49. Despite whether the record has been expunged, have you ever been summoned, charged,

arrested, taken into custody, or indicted for driving under the influence of alcohol or any

other controlled substance? __ Yes __ No

If “yes,” for each incident, provide the date of the incident, the location of the incident, the

investigating law enforcement agency, the name and address of the court of jurisdiction, the

original charge, the ultimate conviction, the sentence imposed by the court including any

educational or treatment requirements, and a factual description of the incident. For each

incident, attach a copy of the arrest or police report, petition or complaint, any diversion

agreement(s), the dismissal or the journal entry of conviction, and any expungement order.

All additional information and documentation should immediately follow this page.

List every incident on a separate sheet of paper to be followed by the appropriate

documentation for each incident. All required documentation must be provided, even

if an order of expungement has been entered. If you have not completed your

sentence or if your crime was a felony, please read Supreme Court Rules 715 and 716

to determine if you are eligible to apply at this time.

50. Despite whether the record has been expunged, other than listed above, have you ever been

Issued a citation, notice to appear or summons, charged, arrested, taken into custody, or

indicted for any felony, misdemeanor, or infraction of the law excluding minor traffic

infractions? __ Yes __ No

If "yes," for each incident, provide the date of the incident, the location of the incident, the

investigating law enforcement agency, the name and address of the court of jurisdiction, the

original charge, the ultimate conviction, the sentence imposed by the court, and a factual

description of the incident. For each incident, attach a copy of the arrest or police report,

petition or complaint, any diversion agreement, the dismissal or the journal entry of conviction,

and any expungement order. All additional information and documentation should

immediately follow this page. List every incident on a separate sheet of paper to be

followed by the appropriate documentation for each incident. All required

documentation must be provided, even if an order of expungement has been entered. If

you have not completed your sentence or if your crime was a felony, please read Supreme

Court Rules 715 and 716 to determine if you are eligible to apply at this time.

51. Since attaining the legal driving age, has your license to operate a motor vehicle ever been

suspended or revoked? __ Yes __ No

If “yes,” provide in the space below the name of the issuing state, the driver’s license

number, the dates of suspension or revocation, and the reason for the suspension(s) or

revocation(s).

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If you answer “yes” to question 52 through 59, attach a separate sheet immediately following

this page, giving the dates and the full facts, including the disposition of each such item. In

addition, attach a copy of the allegations and final disposition, if any, from the authority

responsible for maintaining the record.

52. Have you ever represented to the public or any court that you were an attorney when you were

not in fact admitted to practice in that jurisdiction? __ Yes __ No

53. Have you ever been disqualified from practicing law for any reason before any state or federal

trial or appellate court? __ Yes __ No

54. Have you ever been disbarred, suspended, censured, admonished, or otherwise

reprimanded or disqualified as an attorney, as a member of another profession, or as a holder

of public office? __ Yes __ No

55. Have there ever been or are there now any charges or complaints (formal or informal)

concerning your conduct as an attorney, as a member of any other profession, or as a holder

of public office? __ Yes __ No

56. Have you ever withdrawn any license application, have you ever been denied a license, or have

you ever had a license revoked? __ Yes __ No

57. Has a surety on any bond on which you were the principal been required to pay money on your

behalf, or have you ever been refused a fidelity or other bond? __ Yes __ No

58. Has any professional liability claim been asserted against you arising out of your alleged errors

or omissions? __ Yes __ No

59. Have you ever applied for (including applications that were withdrawn) or held a license for

a business, trade or profession other than as an attorney at law, the procurement of which

required proof of good character and/or an examination (such as certified public accountant,

patent practitioner, or real estate broker)? __ Yes __ No

If “yes,” provide on a separate sheet the date for which you applied for the license, how long

you held the license, the type of license, and the issuing authority (including the complete

address and telephone number for the issuing authority.)

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Continuing Obligation Oath

In the space provided below, copy in your handwriting the following statement:

I swear that the information provided in this application is true and correct to the best of my

knowledge and ability. I acknowledge that any false, misleading, evasive, or incomplete

response on the foregoing application is inconsistent with the truthfulness and candor

required of a practicing attorney and is grounds for a finding that I lack the requisite character

and fitness for admission to the bar in Kansas.

Should an event occur that would change my response to any question on the foregoing

application, I understand that I am required to update my application in writing within 5 days

of such an event. I understand that my obligation to update my application continues through

the time that I am sworn in as an attorney. I further understand that if an event occurs that

would change my response to any question on the foregoing application within 5 days of the

time I am scheduled to be sworn in, I must update my application in writing prior to being

sworn in as an attorney. Failure to update my application may result in the revocation of my

license or attorney discipline. If more space is needed, continue on the back of this page.

_______________________________________

Signature

State of ________________)

County of ______________)

SUBSCRIBED AND SWORN TO before me a notary public within and for said county and state.

My Commission Expires: _________________.

___________________________________

Notary Public

Seal or Stamp

2017

19

I specifically authorize the Board of Law Examiners or its designee(s) to obtain any

information from my official record at any educational institution attended, any past or

present employer, or any credit bureau, collection agency, or any loan or credit granting

person or institution, which may have a bearing on my character and fitness; and I hereby

consent to and authorize the release of any such information.

I hereby, without any mental reservation, state that, except as stated above, by no act or deed

of mine nor by the judgment or decree of any court, nor by the act of any governmental

agency, either domestic or foreign, have I forfeited or changed my citizenship and that, if

admitted to practice law in the State of Kansas, I will bear true allegiance to and support and

defend the Constitution of the United States and the Constitution of the State of Kansas and

the laws thereof.

I fully agree that notwithstanding I am admitted to practice law in the courts of the State of

Kansas by reason of this application, if it should become known hereafter that any statement

herein contained is false, it shall be grounds for the Supreme Court to cancel my certificate of

admission and to disbar me as an attorney at law.

I understand that I have a continuing obligation to advise the Office of Attorney Admissions

of events which would change my response to any question on this application for admission.

I understand that if I pass the examination given, as a condition precedent to my

admission, I shall be required to take the oath (or affirmation) required by the rules of the

Court.

_____________________________________________

Signature (SIGN IN BLUE INK)

STATE OF ______________________________

ss:

COUNTY OF ____________________________

I, _________________________________________________, the petitioner above named, do solemnly swear

that I signed the above and foregoing application, that I have read the said application, and that all statements

therein made are true. So help me God.

______________________________________________

Signature (SIGN IN BLUE INK)

Subscribed and sworn to before me, a Notary Public in and for the above county and state, this _________ day

of __________________________, _____.

______________________________________________

Notary Public (SIGN IN BLUE INK)

My commission expires: _________________

Note: All blanks of the notary certificate must be completed.

2017

20

KANSAS BOARD OF LAW EXAMINERS

AUTHORIZATION AND RELEASE

I, born at ,

(City)

, on .

(State) (Date of Birth) (Soc. Sec. No.)

having filed an application for admission to the Bar of Kansas, hereby consent to have an investigation made

as to my moral character, professional reputation and fitness for the practice of law and such other

information as may be received, all of which will be reported only to the Kansas Board of Law Examiners.

I agree to give any further information which may be required in reference to my past record. I understand

that the contents of my character report are confidential.

I hereby authorize and request every educational, or other institution, hospital, or other medical facility,

physician, person, firm, company, corporation, governmental agency, police authority, court, association or

institution having control of any documents, records and other information requested by the Kansas Board

of Law Examiners or the National Conference of Bar Examiners to furnish to them such information or

records, including documents, bar association files, medical records and physician’s reports, credit history

reports, all criminal history records, and any other pertinent data so requested, and to permit them or any of

their agents or representatives to inspect and make copies of such documents, records and other information.

I hereby authorize the National Personnel Records Center, St. Louis, Mo., or other custodian of my military

record to release to the Kansas Board of Law Examiners any requested information or photo copies from my

military personnel and related medical records. This could include photo copy of my DD form 214, Report

of Separation. My serial number and branch of the military were:

I hereby release, discharge and exonerate the National Conference of Bar Examiners, their agents and

representatives, the Kansas Board of Law Examiners, their agents and representatives, and any party

furnishing information from liability arising out of the furnishing or inspection of such documents, records,

and other information or the investigation made by the National Conference of Bar Examiners or by the

Kansas Board of Law Examiners.

I hereby acknowledge that I am executing three originals of this document and do hereby authorize that they

may be copied by the Kansas Board of Law Examiners and that said copies may be used and accepted as

originals in the same manner and for the same purpose as if they were the original of this document.

I have read the foregoing document and have answered all questions. The answers are complete and truthful

of my own knowledge.

Signature of Applicant (SIGN IN BLUE INK)

STATE OF )

)

COUNTY OF )

Subscribed and sworn to before me this day of , .

Notary Public (SIGN IN BLUE INK)

My commission expires

2017

21