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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:
I have reviewed the information provided in Sections A and B of this application.
The Applicant is in good academic standing.
The Applicant is eligible under the school’s criteria to undertake the activities authorized by Illinois
Supreme Court Rule 711.
The Applicant meets the eligibility requirements for temporary licensure under 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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