Name
Email Address
Firm/Employer
Office Address
Home Address
Office Phone #
Mobile Phone #
2
0
20 SUBSTANTIAL INVOLVEMENT / SELF-STUDY / FEES
% OF PARALEGAL
ACTIVITIES
Mark each box to claim
SELF-STUDY CREDIT
2021
2020
2021
FEE(S)
FEE TYPE
AMOUNT
TBLS FILE #
%
Annual $ 50.00
Total Due: $ 50.00
DISCLOSURE OF CONDUCT
Yes No
Since the filing of your last Annual Reporting Form, have you been:
1. Disciplined or removed from membership by any local paralegal organization or
State Bar related org
anization
2. Disciplined or sanctioned by any court or subject of an UPL complaint by the UPL Committee of the SBOT?
3. Convicted, given probation (whether deferred or not) or fined for a felony or misdemeanor involving moral turpitude or
any other felony?
turpitude or any other felony?
CERTIFIED PARALEGAL’S AGREEMENT / AUTHORIZATION
1. I am currently working under the ultimate direction and supervision of a Texas licensed attorney doing business in the State of
Texas.
2. I authorize all persons and entities to provide to the TBLS or its authorized representative, all information relevant to the
investigation of this application, specifically including records in possession of the Minimum Continuing Legal Education
Department of the State Bar of Texas.
3. I confirm that I have answered all questions on this Annual Reporting Form completely and truthfully, and that all information
provided is accurate and I agree to abide by the provisions of the TBLS Paralegal Rules and Regulations and to pay all fees
required by the TBLS in order to maintain certification. I further agree that all information received by the TBLS shall be
treated confidentially and that I have no right of access to information received by the TBLS from third parties.
___________________________________________
Signature of Board Certified Paralegal
Today’s Date
TESTAMENT OF SUPERVISING ATTORNEY
I am fully aware that a Board Certified paralegal must work under the ultimate direction and supervision of a Texas licensed attorney doing
business in the State of Texas, and attest that the paralegal who has completed and signed this TBLS Paralegal Annual Reporting Form is
employed under my supervision and is performing various paralegal activities and responsibilities in the specialty area(s) in which he/she is
certified. TBLS may, at its option, request at random additional attorneys and/or judges to attest to the applicant’s competence in the
specialty area.
___________________________________________
Signature of Supervising Attorney Today’s Date
Texas Board of Legal Specialization
Mail Check Payment To:
505 E. Huntland Dr., Ste. 400, LB 28 Austin, TX 78752
Paralegal Annual Reporting Form
Due August 15, 2021
