NOTICE OF ADDITIONAL OR CHANGE OF EMPLOYING
AGENCY/SUPERVISING ATTORNEY
ILLINOIS SUPREME COURT RULE 711
To: Administrative Office of the Illinois Courts
222 North LaSalle Street, 13
th
Floor
Chicago, Illinois, 60601
The services authorized by Illinois Supreme Court Rule 711, which I acknowledge I
have read, will be performed by me for:
______________________________________________________________________________
Full Name of Agency
____________________________________________________________________________________________
Agency Address City/State/Zip Code
( )
____________________________________________________________________________________________
Agency Telephone Number Supervising Attorney's Name
(Must be a member in good standing of the Illinois Bar)
The Agency 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
_________________________________ Dated this ______ day of _______________, 20 _____
Supervising Attorney's Signature
For office use only:
_______________________________________
Law School Student's Signature
Approved by: _______________ Date: ________
Name: ________________________________
Address:________________________________
________________________________
Telephone: ______________________________
711 License number: ______________________
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