Application for Admission to Practice as an Attorney and
Counselor-at-Law in the State of New York
New York State Supreme Court Appellate Division
Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York: Form Law School Certicate (11/2020) Page 1 of 3
Form Law School Certificate
Instructions: Applicant must complete the rst portion of this form certicate, sign the form and send it to each
law school listed by the applicant on the application for admission questionnaire (see question number 10).
The law school should complete the remainder of the form and return it directly to the Appellate Division
Department designated below by the applicant.
Completion and submission of this form is a prerequisite to applicant’s admission to the New York State Bar.
TO BE COMPLETED BY APPLICANT:
Name of Applicant BOLE ID # (NYS Board of Law Examiners Identication Number)
B
Current Street Address (Office or Home) City/Town/Village
State ZIP Country (if not USA)
Telephone E-mail
Social Security Number
Name of School
Address of School City/Town/Village
State ZIP Country (if not USA)
TO BE COMPLETED BY SCHOOL ONLY:
Dates of Attendance at Law School From (mm/yyyy) To (mm/yyyy)
Date Graduated from Law School (mm/yyyy) Degree Conferred by School
AUTHORIZATION BY APPLICANT
I (name of applicant), , hereby authorize (name of school)
and persons issuing this certicate to release to
the Appellate Division of the New York State Supreme Court all information, les or records requested by it or its
Committees on Character and Fitness in connection with the processing of my application for admission to the Bar of
the State of New York.
Signature of Applicant
Dated (mm/dd/yyyy)
Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York: Form Law School Certicate (11/2020) Page 2 of 3
Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York
Form Law School Certificate (Continued)
Designation of Appellate Division Department to Which School Should Mail Completed Form:
Applicant must check one of the following:
First Judicial Department
Committee on Character and Fitness, Appellate Division, First Department
41 Madison Avenue, 26th Floor, New York, New York 10010
Telephone: (646) 386-5893
Second Judicial Department
Committees on Character and Fitness, Appellate Division, Second Department
335 Adams Street, Room 2404, Brooklyn, New York 11201
Telephone: (718) 923-6360
Third Judicial Department
Attorney Admissions, Appellate Division, Third Department
P.O. Box 7350, Capitol Station, Albany, New York 12224
Telephone: (518) 471-4778
Express Mail Address:
Appellate Division, Third Department Attorney Admissions
Robert Abrams Building for Law and Justice
State Street, Room 511, Albany, New York 12223
Fourth Judicial Department
Attorney Admissions, Appellate Division, Fourth Department
M. Dolores Denman Courthouse, 50 East Avenue, Suite 200, Rochester, New York 14604
Telephone: (585) 530-3100
Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York: Form Law School Certicate (11/2020) Page 3 of 3
Application for Admission to Practice as an Attorney and Counselor-at-Law in the State of New York
Form Law School Certificate (Continued)
TO BE COMPLETED BY SCHOOL ONLY:
Please conrm whether or not the school information provided by applicant above is accurate.
Yes No (if “No” please explain)
Was applicant charged with any misconduct, or disciplined, suspended, or dropped for any misconduct?
Yes No (if “Yes” please state fully)
Is there any other discreditable information in the personnel or other records of the school regarding the applicant’s
conduct or activities or bearing upon applicant’s character not otherwise set forth in this form certicate?
Yes No (if “Yes” please state fully)
If applicant led a questionnaire or written application containing personal data, please supply a copy
thereof, if available.
Official Seal of School
Signature of Official
Title of Official
Dated (mm/dd/yyyy)
IF THIS CERTIFICATE IS NOT IN ENGLISH, IT MUST BE ACCOMPANIED BY AN ENGLISH TRANSLATION
THAT IS EITHER DULY AUTHENTICATED OR INCLUDES A STATEMENT BY THE TRANSLATOR SETTING
FORTH THE TRANSLATOR’S QUALIFICATIONS AND CERTIFYING THAT THE TRANSLATION IS ACCURATE.
