Character & Fitness Questionnaire

PREAMBLE
If you have questions about the Fitness Application, you should first consult the following:

- Policy Statement of the Fitness Board

- Making the Mark - Character and Fitness for Admission to the Bar

- Frequently Asked Questions
I understand that the above documents are available to answer questions about the Fitness Application.
PERSONAL INFORMATION
Personal Information
Please enter your personal information.

All processing will be done on the basis of your full name; therefore, all records will be maintained and certification(s) issued in your full name. If you do not have a middle name you must indicate by typing ' NMN '.
Full name
By what name are you usually called?
Date of birth
Birth City
Birth State
Birth Country
Contact Information
CONTACT INFORMATION

You are responsible for updating your contact information whenever it changes, up until the time you receive a Certificate of Eligibility to Practice Law. You can update your contact information by clicking on "Edit Personal Info" above.
Email Address
Street or P.O. Box #
Apt. # or Address 2
City
State
ZIP Code
Preferred Contact Number
Alternate Number
Other First, Middle or Last Name
Have you ever been known by another name other than a nickname (e.g. maiden name)?
List each name used, or by which you have at any time been known, and the dates that name was used.
If your name was changed by court order, give the name and location of the court issuing the order and the date of the order. You will need to provide a copy of the court order.
Last Name (Maiden)
First Name
Middle Name
From Mo/Yr
To Mo/Yr
Reason name was used
 
Social Security Number
Have you ever been issued or used any social security number other than the one you provided when you registered an account with the Office of Bar Admissions, or have you ever been issued a similar number in another country?
Provide the social security number(s) you have used and explain the reason why you have had more than one number.
Social Security Number
Explanation
 
Law School
Please choose the name of the law school which conferred or will confer your degree.
Citizenship Information
1.1 Were you born in the United States?
You must provide:
- A copy of your birth certificate.
1.2 Were you born in a foreign country to US citizen parents?
You must provide a copy of the Consular Certificate of Birth Abroad.
1.3 Are you a naturalized United States citizen?
1.4 Do you reside lawfully in the United States as a Permanent Resident?
1.5 Do you currently hold the F-1 student Visa?
You must print, complete and submit the Nonimmigrant Affidavit along with your Fitness Application.
1.6 Have you recently filed an application with United States Citizenship and Immigration Services (USCIS) to adjust your status to that of a Permanent Resident of the United States
Provide a copy of the Notice of Action form issued by the USCIS and provide a copy of the citizenship page of your passport.
If you are not a citizen of the United States or if you are not a Permanent Resident of the United States, you must print, complete, and submit the Nonimmigrant Affidavit, along with your Fitness Application, and provide the required documentation to support the claims made in the Affidavit.
Provide a copy of the front and back of your Permanent Resident Card and provide a copy of the citizenship page of your passport.
Provide a copy of your Certificate of Naturalization or Certificate or Citizenship.
Selective Service
Male citizens and permanent residents who are under 26 years old must be registered with the Selective Service System.

You can verify your registration at: https://www.sss.gov/verify
I have registered with Selective Service
2.2 Selective Service Number
2.1 Please select one:
Please explain
 
Marital Status
3.1 Are you married?
3.2 Enter the full name of your spouse.
Date of Marriage
3.3 Have you ever been widowed, divorced, or had a marriage annulled or set aside?
If a marriage was terminated by court order, you must provide copies of the following documents relating to each divorce: the complaint, answer, order of dismissal, decree or judgment, and settlement agreement.
Please select
3.4 You must provide the name of your former spouse and state when, where, and how your marriage was terminated. If you are widowed, you must provide the name of your deceased spouse.
 
4.1 Have you ever been under court ordered obligation to pay alimony or child support payments?
4.2 State your compliance with such support payments and list the name and last known address of your former spouse(s) or the custodial parent of your child(ren) to whom support is or was to be paid. Please also provide a copy of the court order unless it is already provided by the requirements of the previous question.
Name of Former Spouse/Custodial Parent of Your Child(ren)
Name of Child (Children)
 
Address 1
Address 2
City
State
ZIP Code
Email Address
State your compliance with support payments
 
OTHER JURISDICTIONS
Other Jurisdictions
5.1 Have you ever submitted a character and fitness application for admission to the Bar of any United States jurisdiction (including Georgia)?
5.2 In what state(s) have you applied for admission and when?
You must provide a complete and legible copy of each such application other than Georgia. If not available, you must provide a letter from the jurisdiction stating that the application is not available.
Name of Jurisdiction
Date Applied
Informal Interview or Formal Hearing
5.3 Have you ever, other than as a routine practice, had your fitness to practice law questioned through an informal interview, a formal hearing or by any other means?
Explain for each instance (of questioning, interview, or hearing) including the reason(s) for the questioning, the nature of the questioning, and the outcome.
 
Bar Examination
6.1 Have you ever taken the bar examination in any United States jurisdiction (including Georgia)?
6.2 If yes, provide the following information.
Jurisdiction
Date of Examination
Pass, fail or awaiting result
Denied Admission to the Practice of Law
7.1 Have you ever been denied admission to the practice of law in any jurisdiction, other than for failure of the bar examination, or been denied permission to take the bar examination of any jurisdiction?
Explain the denial of admission, including the name of the denying jurisdiction, the date of the denial, the reason why you were denied and any other information you deem appropriate.
 
Admitted to the Practice of Law
8.1 Have you ever been admitted to the practice of law in any United States jurisdiction including Georgia?
8.2 Indicate in which jurisdiction(s) you have been admitted, the date of admission, and whether it was by Examination or by Motion, and include your State Bar Membership Number.
You must provide a letter of good standing and disciplinary letter for each state in which you are admitted. Not all states issue both documents; therefore, please check with the other states in which you are admitted to determine what will be required.
Name of jurisdiction
Admission Date
Type of application
State Bar Membership Number
Good standing
8.3 Are you in good standing in every state in which you are admitted?
8.4 Indicate which state and explain why you are not in good standing.
State
Explanation
 
Complaints
8.5 Have any complaints been filed against you as an attorney with the disciplinary authority of any state in which you have been admitted to practice?
For each instance in which such a complaint was filed, state the name of the agency, authority, board or committee to whom the complaint was addressed, the date of the complaint, the nature of the complaint, the disposition of the complaint and any other information you deem appropriate.
You must provide copies of all documents and correspondence in each matter.
Name of Agency
Date of the complaint
Action/File/Case Number
Nature of complaint
 
Disposition
 
Other information
 
Discipline
8.6 Have you been the subject of any form of lawyer discipline, whether private or public, whether oral or written, in any jurisdiction in which you have been admitted to the practice of law?
Refer to Part C, Section 2(f) of the Rules Governing Admission to the Practice of Law.
State, for each instance of discipline, the name of the jurisdiction imposing the discipline, the facts and circumstances leading to the discipline, the date of the discipline, the nature of the discipline, the nature of the offense for which the discipline was imposed and any other information you deem appropriate.
Name of jurisdiction
Date of the discipline
Action/File/Case Number
Nature of the discipline
 
Nature of the offense
 
Other information
 
Facts and Circumstances
 
RESIDENTIAL HISTORY
Permanent and Temporary Addresses
9.1 Beginning with your current residence, list every place you have resided for more than three months in the last five years. If you resided on a school campus, you only need to list the name and address of the school.
NOTE: Adding an address on this screen DOES NOT update your current mailing address. To update your current mailing address, login to your homepage and click on "Edit Personal Info".
Resided From
Resided Until
Address Line 1
Address Line 2
City
State or Province
ZIP Code
Country
EDUCATIONAL INFORMATION
College (Excluding Law School)
10.1 Provide the following information for each college and university attended (other than law school).
College Name
Address 1
Address 2
City
State or Province
ZIP Code
Country
Dean of Students' Email
Attended From
Attended To
Degree Conferred
Was this a study abroad program or was it a college outside of the United States?
Please enter any additional information about the program in the Notes field below, including, if necessary, the location of the program and the college through which (if any) the program was taken.
Notes
 
Additional Information
 
Law School
11.1 Provide the following information for each law school you are presently attending as well as each law school you previously attended.
University Name
School Name
Address 1
Address 2
City
State or Province
ZIP Code
Dean of Student's or Registrar's Email
Attended From
Attended To
Degree Conferred or Expected to be Conferred
Was this a study abroad program or was the college outside of the United States.
Please enter any additional information about the program in the Notes field below, including, if necessary, the location of the program and the college through which (if any) the program was taken.
Notes
 
Additional Information
 
Educational Disciplinary
12.1 Have you ever been dropped, suspended, warned, placed on scholastic or disciplinary probation, expelled, or requested to resign from any college, university, or law school or otherwise subjected to written discipline by any such institution or requested or advised by any such institution to discontinue your studies?
List each occurrence and list the date and circumstance of the occurrence(s).
College/University
Date of Occurrence
Circumstance of Occurrence
 
12.2 Have you ever been formally charged with cheating, lying or otherwise taking unfair advantage of fellow students at any college, university or law school you attended or are presently attending?
Provide complete details of each instance, its disposition and the punishment imposed, if any.
College/University
Disposition
 
Punishment imposed
 
Details of instance
 
12.3 Regardless of whether the record has been expunged, cancelled or annulled, or whether no record was made, have you ever been subject to proceedings before a school honor court or council (or any similar body)?
Provide a narrative for each instance including the date, full details of such charges, disposition and the punishment imposed, if any, as well as copies of any documentation or correspondence between you and the institution.
College/University
Date of instance
Details of charges
 
Disposition
 
Punishment imposed
 
MILITARY SERVICE
Armed Forces
13.1 Are you now or have you ever been a member of the armed forces of the United States, including the National Guard, or any of the reserve components?
You must furnish Report of Separation, Form DD214, or its equivalent for each period of active duty.
Dates of periods of active duty:
Start Date
End Date
Branch of Service
Highest Rank Achieved
Date of Discharge
Type of Discharge
If you are currently active in a reserve unit, provide the mailing address of your reserve unit.
I am currently in an active reserve unit.
Address 1
Address 2
City
State
ZIP Code
Country
13.4 As a member of the armed forces, were court martial charges ever made or proceedings instituted against you?
State the date, the nature of the charges, the facts, the disposition of the matter and the location and designation of the military establishment where such proceedings took place.
Date
Nature of the charges
 
Facts
 
Disposition of the matter
 
Location of the military establishment
13.5 As a member of the armed forces, was non-judicial punishment imposed upon you?
For each imposition of non-judicial punishment, give the date, the nature of the offense, the facts surrounding its occurrence and the location and designation of the military unit or command imposing punishment.
Date of imposition
Nature of the offense
 
Facts
 
Location of the military unit
 
13.6 As a member of the armed forces, were you asked to resign or given the opportunity to resign in lieu of judicial or administrative proceedings being instituted or carried out against you?
Give the date of such resignation, the nature of the proceeding which was or would have been instituted against you and the designation of the military unit or command which instituted or would have instituted proceedings against you.
Date of resignation
Nature of the proceedings
 
Designation of the military unit
 
13.7 Have you ever received a medical discharge or an administrative discharge for medical reasons?
Explain the medical reasons for such discharge, the name and address of the medical facility certifying the need for such discharge, and the date of your discharge.
Medical reasons for discharge
 
Date of discharge
Name of the medical facility
Address 1
Address 2
City
State
ZIP Code
Country
EMPLOYMENT
Notification
EMPLOYMENT

On the next page, you will be asked to provide your employment history. You should include all employment, including both law-related and non-law-related positions. We will contact your present and past employers, so please take care to provide the most current contact information available.
Employment History
Provide a complete list of your employment, beginning with your current or most recent employment and going back 10 years or to your 18th birthday (whichever is less). You do not need to disclose isolated or "odd job" employment, such as babysitting, tutoring, or yard work, in which you were employed by an individual at their home for less than 10 hours per week.

In addition, you should list ALL law-related employment, even if that employment was more than 10 years ago. If a law-related position was with a firm that has changed or been dissolved, please provide the name and contact information of a supervisor who previously worked at that firm and can verify your employment.
14.1 Have you ever been employed or had an internship?
Employer Name
Is this Position Law Related?
Supervisor Name or Employment Verification Contact
Your Position
Please indicate whether this position was paid, volunteer, or for academic credit.
Are you currently employed at this job?
Reason for Leaving
 
Date Started
Date Ended
Email Address of Supervisor or Employment Verification Contact
An email address is strongly preferred and will allow us to process your application more efficiently. If this is a legal employer, it is highly likely that you can provide an email address. If you are unable to provide an email address at this time, you may type "unknown" to proceed with your application. You can amend your application after it is submitted with valid email addresses.
Address 1
Address 2
City
State
ZIP Code
Country
Additional Information
 
During all time periods since my 18th birthday (or within the last ten years) not covered in my answer above, I was unemployed or attending school.
Discharge
14.2 Have you ever been discharged from any employment?
For each instance, state the date and circumstances. If the employer was not an individual, state the name and title of the supervisor.
Date
Circumstances
 
Name of Employer
Address 1
Address 2
City
State
ZIP Code
Name of Supervisor
Email address of supervisor or employment verification contact
Discipline
14.3 Have you ever been disciplined by an employer, or requested, formally or informally, to resign from or terminate employment?
For each instance, state the date, circumstances, and provide the name and address for each employer. If the employer was not an individual, state the name and title of the person making such a request.
Date
Circumstances
 
Name of Employer
Address 1
Address 2
City
State
ZIP Code
Country
Name of Supervisor
Email address of supervisor or employment verification contact
CREDIT
Credit Information
15.1 Do you have, or have you during the last five years had, a credit account with any merchant, bank, mortgage company, any other financial institution, credit union, oil company or any other business or credit enterprise?
Provide information on all lines of credit, credit cards and credit accounts, whether used or not and whether now active or not. Include accounts with zero balances. Be sure to include mortgages, car leases, car loans, joint accounts, and accounts on which you are an authorized user. Include information on all accounts for the last 5 years.

DO NOT ENTER STUDENT LOANS IN THIS SECTION. STUDENT LOAN INFORMATION IS LISTED IN QUESTION 16.

DO NOT SEND A COPY OF YOUR CREDIT REPORT FROM ANY CREDIT REPORTING AGENCY IN LIEU OF COMPLETING THIS QUESTION!


For purposes of updating please note: You are required to amend all changes with regard to credit except changes in monthly credit balances.
15.2 Credit Accounts Information
Creditor
Account Type
Approximate Balance Currently Owed do not include "$"
Collection Agency
15.3 Have you ever had any type of account or debt turned over to a collection agency or an account that has been charged off?
If your answer to this question is "Yes," you must read the Policy Statement of the Board to Determine Fitness of Bar Applicants Regarding Character and Fitness Reviews, which you can find here. You should pay special attention to Section D. Neglect of Financial Responsibilities.

Click here to access the Policy Statement.
I have read and understand this policy.
Give the name and address of the creditor, account number, current balance, and describe the steps you have taken to satisfy the debt. If the account is paid in full, you must provide demonstrable proof.
Name of Creditor
Address 1
Address 2
City
State
ZIP Code
Country
Account Number
Current Balance
Describe the steps you have taken to satisfy the debt.
 
Creditor Judgment
15.4 Has a judgment ever been entered against you in favor of a creditor or any other entity?
If your answer to this question is "Yes", you must read the Policy Statement of the Board to Determine Fitness of Bar applicants Regarding Character & Fitness Reviews which is published on the Georgia Bar Admissions website. You should pay special attention to paragraph C. Neglect of financial responsibilities.

Click here to access this document.
I have read and understand this policy.
Name of Holders
Address 1
Address 2
City
State
ZIP Code
Country
Additional Information
 
List the names and present mailing addresses of the holders and furnish copies of such judgments.
If satisfied, you should provide copies of the satisfaction of judgment.

If not satisfied, you should provide a statement concerning the current status of the judgment, including copies of any correspondence concerning payment of the judgment.
Liens or Garnishments
15.5 Have you ever had any liens or garnishments filed against you?
If your answer to this question is "Yes", you must read the Policy Statement of the Board to Determine Fitness of Bar applicants Regarding Character & Fitness Reviews which is published on the Georgia Bar Admissions website. You should pay special attention to paragraph C. Neglect of financial responsibilities.

Click here to access this document.
I have read and understand this policy.
Provide the names and addresses of the holders; the amounts of the liens or garnishments and, if satisfied, furnish certified copies of the satisfactions.
Name of Holder
Address 1
Address 2
City
State
ZIP Code
Country
Amount of Lien
Amount of Garnishment
Additional Information
 
Bankruptcy
15.6 Have you ever filed a petition in bankruptcy or for establishment of a wage earners plan?
If your answer to this question is "Yes", you must read the Policy Statement of the Board to Determine Fitness of Bar applicants Regarding Character & Fitness Reviews which is published on the Georgia Bar Admissions website. You should pay special attention to paragraph C. Neglect of financial responsibilities.

Click here to access this document.
I have read and understand this policy.
For each filing, list the court in which such petition was filed, the date of filing and the final disposition of the matter. You must include a copy of the petition, list of creditors, and the order of discharge.
Type of Bankruptcy
Name of Court
Date of Filing
Case Number
Final Disposition
 
Reason for Bankruptcy
 
Additional Information
 
STUDENT LOANS
Student Loan
For student loans that were satisfied over 10 years ago and do not appear on your credit report select "No".
16.1 Have you ever obtained a student loan?
16.2 Are your student loans in deferment?
16.3 Are your student loans in forbearance?
16.4 Total amount of student loans owed
16.5 Have you ever defaulted on a student loan?
* It is recommended that you pull a current credit report to verify the status of any loans.
You must provide complete mailing addresses including ZIP codes.
Loan Holder
Address 1
Address 2
City
State
ZIP Code
Country
Account Number
Original Loan Amount
Amount Currently Owed
Explanation of Default
 
Defaulted on a Student Loan
16.3 Have you ever defaulted on a student loan? You must answer even if the debt is now satisfied.
If your answer to this question is "Yes", you must read the Policy Statement of the Board to Determine Fitness of Bar applicants Regarding Character & Fitness Reviews which is published on the Georgia Bar Admissions website. You should pay special attention to paragraph C. Neglect of financial responsibilities.

Click here to access this document.
I have read and understand this policy.
Give the name and address of the creditor, the loan account number, the amount owed and, if still in default, what steps have been taken to bring the account up-to-date.
Provide current documentation from your lender or servicer showing the status of each defaulted student loan.
Guarantor/Lender
Address 1
Address 2
City
State
ZIP Code
Account Number
Default Amount
Amount Currently Owed
Date Defaulted
State the steps you have taken to bring the account up-to-date.
 
Student Loan Judgment
16.4 Has a judgment ever been entered against you in favor of a student loan guarantor or lender?
If your answer to this question is "Yes", you must read the Policy Statement of the Board to Determine Fitness of Bar applicants Regarding Character & Fitness Reviews which is published on the Georgia Bar Admissions website. You should pay special attention to paragraph C. Neglect of financial responsibilities.

Click here to access this document.
I have read and understand this policy.
Provide the names and present addresses of the holders.
You must furnish certified copies of such judgments and, if satisfied, satisfactions of judgments.
Name of Holder
Address 1
Address 2
City
State
ZIP Code
Country
Additional Information
 
BUSINESS OWNERSHIP
Business Ownership
17.1 Are there any businesses, corporations, organizations, partnerships, professional associations, or individual partnerships in which you own or have owned a 50% or greater interest?
Litigation
17.3 Have you ever been involved in any litigation or arbitration related to the business or businesses referred to in the previous section?
Describe all litigation, including arbitration and governmental hearings in which business listed in the previous question has been involved.
Explanation
 
17.4 Have there been had any decrees, judgments, or liens against the business or businesses referred to in the previous section?
List any decrees, judgments, liens or orders and amounts against business entered against the business or businesses referred to in the previous section.
Explanation
 
CIVIL LITIGATION
Litigation
18.1 Have there been any instances of litigation (equity, actions at law, statutory proceedings, lunacy, guardianship, or any other civil or administrative proceeding, other than bankruptcy) in which you have been a party or that you initiated or that was initiated on your behalf?
This question does not pertain to a class action law suit in which you were or are a plaintiff.
Complete the following for each instance of litigation. You may be asked to provide copies of the complaint, answer, order of dismissal or judgment, and settlement agreement (if any) filed in connection with each instance of litigation.
18.2 Civil Litigation Information
Date
Court / Agency
Case Name and Number
Name of Plaintiff
Name of Defendant
Nature of Proceedings
 
Disposition
 
DRIVER'S INFORMATION
Driver's License
Do you hold a driver's license?
For each jurisdiction, including Georgia, in which you have held a driver's license during the last 12 months, you must submit a CERTIFIED copy of your official driving record. The record should include the maximum number of years the state provides (seven years for Georgia) and be dated within thirty days of the submission date.
Driver's License Number
State
Date Issued
Expiration Date
Traffic Violations
19.1 Excluding parking violations, have you been cited or charged with more than five traffic violations within the past five years (including violations to which you were allowed to enter a "nolo contendere" plea)?
19.2 Please provide information on each of those violations to the best of your ability.
Please do not include charges of Driving under the Influence of Drugs or Alcohol (DUI, DWI, etc.) in your answer to this question. You will be required to list all DUI charges in response to question #20.
Date
Nature of Violation
 
Name of Court
Address 1
Address 2
City
State
ZIP Code
Disposition or Status
 
Other Licenses
List each state or jurisdiction and the approximate date the license or permit was initially issued.
For each jurisdiction, including Georgia, in which you have held a driver's license during the last 12 months, you must submit an Official Driving Record.

If you obtain a driver's license from another state or jurisdiction (including Georgia) after filing this application, you must submit a CERTIFIED copy of your official driving record from that agency as well.
19.3 Excluding your current driver's license, have you applied for or been issued a driver's license or an operator's permit by any other state or jurisdiction?
For each jurisdiction, including Georgia, in which you have held a driver's license during the last 12 months, you must submit a CERTIFIED copy of your official driving record.The record should include the maximum number of years the state provides (seven years for Georgia) and be dated within thirty days of the submission date.
Date Issued
Date License Surrendered or Expired
State
Suspended License
19.4 Has your driver's license ever been suspended or revoked?
Name of Agency
Address 1
Address 2
City
State
ZIP Code
Country
Date of Suspension or Revocation
Length of Suspension
Reason for Suspension or Revocation
 
Current status of license or other facts which may be pertinent
 
DUI
20 Driving Under the Influence
20.1 Have you ever been charged with or cited for driving under the influence of alcohol or drugs?
Date you were charged or cited
Agency (Police Department)
Address 1
Address 2
City
State
ZIP Code
Disposition
Date of Disposition
Are you currently serving a probated sentence?
You are required to provide a detailed narrative of the facts and circumstances surrounding each offense as well as copies of the arresting officer's report (including any citations) and all court documents for each charge.
Facts and circumstances surrounding each offense
 
Have you completed all the requirements of the court?
If you have not, explain what you have not completed and why.
Explain what you have not completed and why.
 
CRIMINAL PROCEEDINGS
Criminal Proceedings
Before you complete this section, you must read the Policy Statement of The Board To Determine Fitness of Bar Applicants Regarding Character And Fitness Reviews, Part A - Unlawful Conduct, which is published on the Georgia Bar Admissions Website.

Click Here to access this document.
I have read and understand this policy.
21.1 Have you ever been detained, arrested, formally accused, cited or prosecuted for the violation of any law?
Excluding traffic offenses, you must disclose each instance even though the charges may have been dismissed or you were acquitted or allowed to plead nolo condendere or adjudication was withheld or a conviction was reversed, set aside, or vacated or the record sealed or expunged and regardless of whether you have been told by anyone, including a judge or a lawyer, that you need not disclose any such instance.
You must to provide copies of all court documents relating to each instance in which you were detained, arrested, formally accused, cited or prosecuted for the violation of any law.
If a fine was paid and court was not attended, you must provide the name and address of the entity to which the fine was paid.
Date of Charge
Nature of Offense
 
City
State
Name of Court
Court Address
City
State
ZIP Code
Disposition
 
Date of Disposition
Did this offense result in a sentence of confinement in a state prison or penitentiary for a period of one year or more, even if such sentence or imprisonment was suspended?
Did this offense result in the conviction of a felony?
Have you applied for or received a full pardon (or in the alternative have you received restoration of your civil rights) for that crime?
Provide a detailed narrative of the facts and circumstances surrounding each charge.
 
You must provide copies of all court documents.
21.6 Are you currently serving a probated sentence as a result of any criminal charge?
Indicate which charge and the date your probation is scheduled to be completed.
Charge
 
Date of completion
Unauthorized practice of Law
22.1 Have you ever been charged with or been under investigation for the unauthorized practice of law?
Provide a written explanation of each charge.
You must provide copies of all correspondence between you and the investigative body as well as copies of that body's reports in each charge or investigation for the unauthorized practice of law.
Explanation
 
Immunity
23.1 Have you ever been offered immunity from prosecution in any criminal action or criminal proceeding?
State the place, date, the name of the defendant, the nature of the act or the proceeding, the court and the circumstances.
Place
Date
Name of Defendant
Nature of act or proceeding
 
Name of Court
Circumstances
 
GENERAL QUESTIONS
PREAMBLE
The purpose of the following questions is to determine the current fitness of an applicant to practice law. All information provided in this application is kept strictly confidential. The vast majority of applicants are certified as fit to practice law; the Board on very rare occasion denies certification to applicants whose current ability to function is significantly impaired in a manner relevant to the practice of law or to applicants who demonstrate a lack of candor by their responses. This is consistent with the public purpose that underlies the Board’s responsibilities. Conversely, the Board does not deny certification to applicants based on their decision to seek treatment or support for a mental health condition. In fact, the Board encourages applicants to seek treatment if needed and believes that an applicant’s decision to obtain necessary treatment is indicative of a person who possesses the character and fitness requisite to be a member of the Bar of Georgia.
I have read and understand this preamble.
Conditions
24 Within the past two years, have you had any condition or impairment (including, but not limited to, substance use, alcohol use, or a mental, emotional, or nervous disorder or condition) that would substantially inhibit your ability to practice law in a competent, ethical, and professional manner? If you have been or are being treated for a condition so that it does not currently affect your ability to practice law in a competent, ethical, and professional manner, then you need not disclose it.
Are the limitations caused by your condition or impairment reduced or ameliorated because you receive ongoing treatment or because you participate in a monitoring or support program?
Note: Please be aware that you may be asked to contact your treating physician, counselor and/or hospital and request that your records and/or a summary of your treatment be sent to the Office Bar Admissions. The Board to Determine Fitness of Bar Applicants is aware of HIPAA requirements.
Describe the condition or impairment
 
Summary of the course of the condition or impairment, including the conduct, symptoms and circumstances that precipitated treatment.
 
Note: Please enter each facility and/or provider as a separate entry. Use "Add More" button at bottom of page to add additional providers.
Name of attending Physician or Counselor
Name of Hospital or Institution
Address 1
Address 2
City
State
Zip Code
Description of any treatment and/or monitoring program, dates of treatment, and results of treatment.
 
Functioning
25 Has your functioning at school or at work ever been sufficiently impaired (as the result of substance abuse, alcohol abuse, or a mental, emotional, or nervous or behavior disorder or condition) as to require inpatient treatment?
Note: Please be aware that you may be asked to contact your treating physician, counselor and/or hospital and request that your records and/or a summary of your treatment be sent to the Office Bar Admissions. The Board to Determine Fitness of Bar Applicants is aware of HIPAA requirements.
Describe the condition or impairment
 
Summary of the course of the condition or impairment, including the conduct, symptoms and circumstances that precipitated treatment.
 
Note: Please enter each facility and/or provider as a separate entry. Use "Add More" button at bottom of page to add additional providers.
Name of attending Physician or Counselor
Name of Hospital or Institution
Address 1
Address 2
City
State
Zip Code
Description of any treatment and/or monitoring program, dates of treatment, and results of treatment.
 
Condition Used as Defense
26 Within the past five years, have you asserted any condition or impairment as a defense, in mitigation, or as an explanation for your conduct in the course of any inquiry, any investigation, or any administrative or judicial proceeding by an educational institution, government agency, professional organization, or licensing authority, or in connection with an employment disciplinary or termination procedure?
Note: You must upload or mail in copies of all pertinent records with regard to your answer to Question 26.
Provide an explanation, including all relevant dates
 
Name of entity before which the issue was raised (i.e., court, agency, etc.)
Address 1
Address 2
City
State
ZIP Code
Disposition, if any
 
Date of Disposition
Other Licenses
27 Excluding a license to practice law, have you ever applied for a state or local license in order to pursue a career, such as a real estate license, a professional license, etc.?
License Type
Licensing Agency
Agency Address
City
State
ZIP Code
Application Date
Were you required to show proof of good character?
Was an Exam Required
Was the license issued?
Date License was Issued
License Number
Is the license currently valid?
Provide a full explanation as to why the license is no longer valid.
 
Please explain the reason for non-issuance
 
Disciplinary Proceedings
28 Have any disciplinary proceedings been instituted against you on behalf of any licencing agency?
Name of person or agency instituting proceedings
Address 1
Address 2
City
State
ZIP Code
Disposition
 
REFERENCES
Personal References
Provide the names and email addresses of five personal references who have known you well within the past five years.
Do not list:

a) your spouse, a relative (including in-law), current roommate, or any current fellow student at your law school;
b) your present or former employer or supervisor;
c) more than one professor at your law school; or
d) more than one member of the same household.
Prefix
First Name
Last Name
Email Address