1. GENERAL INSTRUCTIONS:

• (a) Please read the application carefully and typewrite or legibly write your answers.

• (b) Be sure that the application BEARS YOUR VERIFIED SIGNATURE and includes the ENCLOSURES required by SCR 49.1(1)(b) (listed in number 5 below).

2. NUMBER OF COPIES, WHERE SENT: Send the original application with enclosures, plus one (1) copy to:

3. FEES: Fees are waived for this limited practice certification.

4. ELIGIBILITY: Any inactive member of the State Bar of Nevada in good standing, or, any attorney
in good standing in another U.S. state, territory, or the District of Columbia, who meets the requirements
under this rule may apply.

5. ENCLOSURES: The following completed documents must be enclosed with your application:5. ENCLOSURES: The following completed documents must be enclosed with your application:

6. LIMITED PRACTICE: An emeritus attorney certified under this rule may practice only through an
approved EAPB program, as defined in Rule 49.2

7. RENEWAL: n attorney certified by the State Bar of Nevada to practice under this rule who
otherwise remains eligible to practice must annually renew the certification in accordance with
Rule 49.4.

8. DISCIPLINE AND BAR MEMBERSHIP: An attorney certified to practice under this rule does not
qualify for active membership in the State Bar of Nevada, but shall be subject to the jurisdiction of the
court and disciplinary boards of this state with respect to the law of this state governing the conduct of
attorneys to the same extent as members of the State Bar of Nevada. Pending final disposition of any
disciplinary matter, the court or the state bar may suspend any right to practice that is granted under this
rule, without notice or hearing. During the time any attorney is certified under this rule, the attorney
shall comply with the same requirements for continuing legal education as may be prescribed for active
members of the State Bar of Nevada.

9. TERMINATION OF CERTIFICATION : Certification to practice under this rule shall terminate
whenever the attorney ceases to be associated with an EAPB program.

Before the State of Nevada Office of Admissions:

PART 1: GENERAL INFORMATION

I hereby furnish the following information under oath. I understand that it is my duty and obligation to answer each question
fully and completely, to make full disclosure of any information requested herein, to provide true and correct answers to all
questions, to correct any answers that may be misleading or confusing, and to inform the State Bar of any changes to the
information provided in connection with my application for certification in order that the information supplied herein shall at
all times be true and correct. I further understand that failure to comply with the above representations may result in my
application being denied.

PART 2: Education

State the name and address of each college, university, law school, or other institution of post-high school learning, which you
have attended since graduation from high school. List if any, the degrees received and the graduation date.

PART 3: BACKGROUND INFORMATION

Check one: All enclosures are attached OR Enclosure(s) will be sent separately

I hereby acknowledge that I have read the foregoing application and its enclosures and that all information provided attendant thereto is complete and true to the best of my knowledge and belief.

Verification

That I have read the foregoing application and that the facts stated in it are complete and true to the best of my knowledge and belief.

On day of , , personally appeared before me, a notary public, , personally known (or proved) to me to be the person whose name is subscribed to the foregoing APPLICATION FOR ADMISSION TO PRACTICE LAW IN THE STATE OF NEVADA UNDER SCR 49.1(1)(b), who acknowledged to me that he/she executed the foregoing document.

Applicant: Please have an authorized representative of the EAPB program you have selected
complete this form and give you to return with your original application for certification as an
emeritus attorney to the Admissions Department of the State Bar of Nevada.

EAPB Provider:

I am an authorized representative of , an approved EAPB Provider pursuant to SCR 49.1(1)(b) on file with the State Bar of Nevada. By signing below, I confirm that the above-named applicant will provide pro bono legal services with his/her EAPB Provider.

Additional Information

Contact information, if different than that on file with the State Bar of Nevada

This form is part of the application for certification under SCR 49.1(1)(b), please return to:

Please direct all questions to the Access to Justice Director, Brad Lewis, (702)-382-2200.

TO: ONLY those applicants applying for admission to the State Bar of Nevada under SCR 49.1(1)(b) and admitted to the practice of law in another jurisdiction

RE: Request for a Certificate of Good Standing and Discipline History Report

The State Bar of Nevada requires that an applicant admitted to the practice of law in any other
jurisdiction(s) obtain a Certificate of Good Standing and Discipline History Report from those
jurisdictions(s).

The top portion of the attached form must be completed by the applicant for each jurisdiction
where the applicant has been admitted to the practice of law. Download any additional forms
as necessary for each jurisdiction.

Upon completion of the attached form, send it to the proper agency that handles disciplinary matters for that jurisdiction. Please include the required payment, if any, to the jurisdiction that you have requested information.

It is the applicant’s sole responsibility to request both a Certificate of Good Standing and a Discipline History Report and have it timely sent to the State Bar of Nevada. Failure to do so will result in the applicant being placed on hold until the proper documentation is received by the State Bar of Nevada.

STATE BAR OF NEVADA

REQUEST FOR
Certificate of Good Standing and/or
Disciplinary History

To whom this may concern: