Appointed Counsel Application

Name*

Attorney Registration #*

Telephone Number*

Fax Number

Email*

Firm Name and Address*

Law School Attended*

Date Graduated*

Date Admitted to Practice in Ohio*

Date Annual DBA Criminal Law Certification Seminar Attended*

If yes, date:

Number of years of experience practicing in the area of criminal law:*

If yes, date:

I have reviewed and understand the requirements set forth in Ohio Admin.Code 120-1-10 for the appointment of counsel and certify that I meet the minimum requirements to be appointed to represent indigent defendants. I am willing to serve as counsel in accordance with and subject to all applicable rules, guidelines, and statutes that govern this process. I agree to notify the Court, in writing, of any changes in personal or professional status that would affect my ability or qualification to serve as appointed counsel for indigent defendants. I understand that Appointed Counsel Payment Packages must be timely submitted and that each package must include an executed Financial Disclosure Form (OPD-206R).

Signature*

Signature Date*

Appointed Counsel Application

Qualifying Experience

Court Hours

Contact Information