United States District Court Northern District of Illinois
`MOTION FOR LEAVE TO APPEAR PRO HAC VICE
`Case Title:
`VS.
`Plantiff(s)
`Defendant(s)
`Case Number: Judge:
`I, hereby apply to the Court
`under Local Rule 83.14 for permission to appear and participate in the above-entitled action on behalf of
`by whom I have been retained.
`I am a member in good standing and eligible to practice before the following courts:
`Title of Court Date Admitted
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`I have currently, or within the year preceding the date of this application, made pro hac vice applications to this
`Court in the following actions:
`Case Number Case Title
`Date of Application
`(Granted or Denied)*
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`*If denied, please explain:
`(Attach additional form if
`necessary)
`Pursuant to Local Rule 83.15(a), applicants who do not have an office within the Northern District of Illinois must designate, at the
`time of filing their initial notice or pleading, a member of the bar of this Court having an office within this District upon who service of
`papers may be made.
`Has the applicant designated local counsel? Yes No
`If you have not designated local counsel, Local Rule 83.15(b) provides that the designation must be made within thirty (30) days.
`Case: 1:16-cv-08637 Document #: 8039 Filed: 11/05/25 Page 1 of 2 PageID #:694041
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`Has the applicant ever been:
`sanctioned, censured, suspended, disbarred, or otherwise disciplined by
`any court?
`or is the applicant currently the subject of an investigation of the
`applicant’s professional conduct?
`transferred to inactive status, voluntarily withdrawn, or resigned from the
`bar of any court?
`denied admission to the bar of any court?
`Yes No
`Yes No
`Yes No
`Yes No
`held in contempt of court? Yes No
`NOTE: If the answer to any of the above questions is yes, please attach a brief description of the incident(s) and the applicant’s current
`status before any court, or any agency thereof, where disciplinary sanctions were imposed, or where an investigation or investigations
`of the applicant’s conduct may have been instituted.
`I have read the Rules of Professional Conduct for the Northern District of Illinois and the Standards for Professional Conduct within
`the Seventh Federal Judicial Circuit, and will faithfully adhere to them. I declare under penalty of perjury that the foregoing is true and
`correct.
`S/
`Date Electronic Signature of Applicant
`Applicant’s Name
`Applicant’s Law Firm
`Last Name First Name Middle Name/Initial
`Applicant’s Address
`Street Address Room/Suite Number
`City State ZIP Code Work Phone Number
`Email Address
`(The pro hac vice admission fee is $150.00 and shall be paid to the Clerk. No admission under Rule 83.14 is effective until such
`time as the fee has been paid.)
`NOTE: Attorneys seeking to appear pro hac vice may wish to consider filing a petition for admission to the general bar of this Court. The
`fee for admission to the General Bar is $18 .00 The fee for pro hac vice admission is $150.00. Admission to the general
`bar permits an attorney to practice before this Court. Pro hac vice admission entitles an attorney to appear in a particular
`case only. Application for such admission must be made in each case; and the admission fee must be paid in each case.
`Rev. /3/20
`11/5/2025
`Case: 1:16-cv-08637 Document #: 8039 Filed: 11/05/25 Page 2 of 2 PageID #:694042
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