ILLINOIS SUPREME COURT
VOLUNTEER PRO BONO PROGRAM ATTORNEY APPLICATION
CERTIFICATION, AUTHORIZATION FOR RELEASE, AND WAIVER
I authorize the Administrator of the Attorney Registration and Disciplinary Commission
and the Illinois Supreme Court to disclose to its Administrative Office all information contained
in the files of the Attorney Registration and Disciplinary Commission concerning my present
status, any complaints which have been made against me, the disposition of those complaints,
and the contents of this application. I expressly waive any right to confidentiality I may possess
with respect to this information.
I authorize the Illinois Supreme Court, the Administrative Office of the Illinois Courts, or
individual appointed by it to discuss the contents of this application with any judge, attorney, or
individual deemed appropriate for the purpose of evaluating my application to the Illinois
Supreme Court’s Pro Bono Program.
I recognize, accept, and agree that any attorney or judge, who is contacted by the
Administrative Office of the Illinois Courts or other individual appointed by the Illinois Supreme
Court to investigate or evaluate my application, must supply the requested information in
fulfillment of his or her professional responsibilities. Information supplied is subject to privilege
and may not be the basis for any claim or cause of action whatsoever on my part.
I agree that any person furnishing information concerning my fitness for admission to the
Illinois Supreme Court’s Pro Bono Program shall be immune and held harmless with respect to
any claim or action by myself. I hereby expressly waive and agree to forego any claim or cause
of action against any person providing or receiving any information related to my application to
or participation in the Illinois Supreme Court’s Pro Bono Program and expressly agree to hold
harmless all such people.
I certify all statements made in this application are true, complete, and correct.
Name (please print clearly): ___________________________________________________
Signature of Applicant: _______________________________________________________
Date of Signature: ___________________________________________________________
Please return the application to:
Administrative Office of the Illinois Courts, Attention - Gabriela Conley, 222 N. LaSalle, 13
Tel. 312-793-2558 or Email firstname.lastname@example.org