Fillable UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS (US Courts)

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UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS (US Courts)

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[If you need additional space for ANY section, please attach an additional sheet and reference that section.]
Rev. 06/23/2016
[If you need additional space for ANY section, please attach an additional sheet and reference that section.]
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ILLINOIS
Plaintiff(s)
v.
Defendant(s
)
)
)
)
)
)
)
)
Case Number:
Judge:
MOTION FOR ATTORNEY REPRESENTATION
(NOTE: Failure to complete all items may result in the denial of this motion. )
1. I, ____________________________________, declare that I am the (check appropriate box)
plaintiff defendant in this case and that I am unable to afford the services of an
attorney. I hereby ask the Court for an attorney to represent me in this case.
2. I declare that I have contacted the following attorneys/organizations seeking representation:
(NOTE: This item must be completed.)
but I have been unable to find an attorney because:
3. I declare that (check all that apply):
(Now:)
I am not currently represented by an attorney requested by the Court in any federal
criminal or civil case.
OR
I am currently represented by an attorney requested by the Court in a federal criminal
or civil case. The case is described on the back of this page.
(Earlier:)
I have not previously been represented by an attorney requested by the Court in any
federal criminal or civil case.
OR
I have previously been represented by an attorney requested by the Court in a federal
criminal or civil case. The case is described on the back of this page.
4. I declare that (check ·one):
I have attached an original Application for Leave to Proceed In Forma Pauperis
detailing my financial status.
[If you need additional space for ANY section, please attach an additional sheet and reference that section.]
Rev. 06/23/2016
[If you need additional space for ANY section, please attach an additional sheet and reference that section.]
I have previously filed an Application for Leave to Proceed In Forma Pauperis in this
case, and it is still true and correct.
I have previously filed an Application for Leave to Proceed In Forma Pauperis in this
case. However, my financial status has changed and I have attached an Amended
Application to Proceed In Forma Pauperis to reflect my current financial status.
5. I declare that my highest level of education is (check one):
Grammar school Some high school High school graduate
Some college College graduate Post-graduate
6. I declare that my ability to speak, write, and/or read English is limited because
English is not my primary language. (Check only if applicable.)
7. I declare that this form and/or other documents in this case were prepared with the
help of an attorney from the U.S. District Court Pro Se Assistance Program. (Check
only if applicable.)
8. I declare under penalty of perjury that the foregoing is true and correct.
_____________________________ ___________________________________________
Signature of Movant Street Address
_____________________________ ___________________________________________
Date City, State, Zip
Other cases in which an attorney requested by this Court has represented me:
Case Name: _________________________________________ Case No.: _________________
Attorney’s Name: ________________________ This case is still pending Yes No
The appointment was limited to settlement assistance: Yes No
Case Name: _________________________________________ Case No.: _________________
Attorney’s Name: ________________________ This case is still pending Yes No
The appointment was limited to settlement assistance: Yes No
Case Name: _________________________________________ Case No.: _________________
Attorney’s Name: ________________________ This case is still pending Yes No
The appointment was limited to settlement assistance: Yes No
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UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS (US Courts)

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Completed 11 June 2021

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