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Adopted 10/20
Section B. (to be completed by Supervising Attorney)
The services authorized by Illinois Supreme Court Rule 711, which I acknowledge I have read, will
be performed under my supervision by .
Applicant/Student's Name
Employer Name Supervising Attorney Name and ARDC #
Employer Address City/State/Zip
Employer Telephone Supervising Attorney Email Address
The Employer indicated above is (check appropriate box):
A legal aid bureau, legal assistance program, organization or clinic chartered by the State of Illinois
or approved by a law school approved by the American Bar Association
The Office of the Public Defender
A law office of the state or any of its subdivisions
I hereby ce
rtify that the information in Section B is accurate and true.
/
Supervising Attorney (Signature) / Date
Section C. (to be completed by the Dean of Applicant’s law school)
By checking the below boxes, I hereby certify the following information is accurate and true:
The Applicant is a graduate of the above-named law school.
I have reviewed the information provided in Sections A and B of this application.
The Applicant meets the eligibility requirements for temporary licensure under Illinois Supreme Court
Rule 711.
I have no objection to the Applicant being authorized to perform the services described in Illinois
Supreme Court Rule 711.
/
Dean of Law School (Signature) / Date (Dean’s Office email address for all 711 correspondence)
For Office Use Only: Approved by: _______________ Date: __________ Expiration Date:__________
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