PENNSYLVANIA IOLTA BOARD
Form for PRO HAC VICE ADMISSION
(For all nonresident attorneys requesting permission to participate in proceedings in a Pennsylvania Court)
Note: * Denotes a required field.
Applicant Name:* 
* Last * First Middle
 
 
    * Date of Birth
Your Firm's Name & Mailing Address:
* Firm Name
* Street / P.O. Box     Ste. No. Address 2 Address 3    
       
 
* City * State * Zip Code * Country  
   
Ext.
* Office Phone * Office Fax
Your Firm's Physical Address:
   
* Street     Ste. No. Address 2 Address 3    
       
 
* City * State * Zip Code * Country  
   
Acknowledgement Letter should be provided to:
* Contact Name Contact Fax Contact E-Mail * Delivery Preference
Name & Office Address of Attorney of Record in the Pennsylvania Proceeding who is filing the Motion for your admission Pro Hac Vice:
 
* PA I.D. Number
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* Name Firm Name
 
* Street/P.O. Box     Ste. No. Address 2 Address 3  
     
 
* City * State * Zip Code  
 
Ext.
Office Phone Office Fax
Sponsor's E-Mail * Delivery Preference
Add one or more cases by using the link below:
(The fee is calculated per attorney per case.)
* Add Case Information  
List all foreign, state and federal jurisdictions in which you have been qualified, licensed or admitted to practice law and are currently active and in good standing, the year of licensure, and your license or bar card numbers, if applicable.
Primary Jurisdiction:
* Jurisdiction: * Year of Licensure: * License Number:
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Other Jurisdictions:
Add Another Jurisdiction
If you have ever practiced law under another name, please state that name here. List also all jurisdictions in which you practiced law under that name, license number, and the time period involved.
Add Name
* Are you familiar with the Pennsylvania Rules of Professional Conduct, Pennsylvania Rules of Disciplinary Enforcement, and the rules and court procedures of the court before which you seek to appear, and will you at all times abide by and comply with the same so long as such Pennsylvania proceeding is pending and you have not withdrawn as counsel therein?
* My client is proceeding in forma pauperis:
Please attach the Motion to proceed in forma pauperis or the Order granting the motion:

Select a file from your computer to upload and attach to your application form (Accepted file-types are .jpg, .gif, .pdf, .tif. The uploaded file(s) must be less than or equal to 2 MB in size):
 
Current Uploads:
* 
 

Signature
* Type the Applicant's Full Name in the box above.
* Date of Application
20181210234009526
* Jurisdiction:  
* Year of Licensure:
License #:
* Jurisdiction:  
* Year of Licensure:
License #:
* Name:  
* Jurisdiction:  
License #'s:
* Time Period:  
* Name:  
* Jurisdiction:  
License #'s:
* Time Period:  
* Case #:  
* Case Name:
Term:
* PA Court:  
Locations(Judicial District):
* Case #:  
* Case Name:
Term:
* PA Court:  
Locations(Judicial District):
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