Declaration for Limited Practice

I, Applicant Name	, seek a limited license to practice in Pennsylvania pursuant to Order No. 837 of the Pennsylvania Supreme Court dated April 28, 2020, permitting limited practice by persons unable to sit for the July 2020 bar examination because of COVID-19. I will work under the supervision of a Pennsylvania-licensed attorney, who is named below and who meets the qualifications of Order No. 837. I understand that, if the supervision of my work by my named supervisor ends, my limited license to practice law in Pennsylvania will expire and I must notify the Board of Law Examiners. Additionally, I certify and agree to the following:

1) I meet all qualifications enumerated in Order No. 837.

2) I will submit an amendment to the Board of Law Examiners within five days of any occurrence that bears on my character and fitness to practice law. I will also promptly submit any name, phone, address or email changes to the Board that may occur during my limited license.

3) I have read, am familiar with, and agree to abide by the Pennsylvania Rules of Professional Conduct and the Pennsylvania Rules of Disciplinary Enforcement.

4) I submit to the jurisdiction of the Pennsylvania Supreme Court with respect to any and all disciplinary matters that may arise during the period of my limited license.

5) My limited license will become effective when I receive written certification from the Board of Law Examiners.

6) I agree that, should I no longer meet the requirements of Order No. 837, I shall so inform the Board of Law Examiners and my supervising attorney within one business day and, if I am informed by the Board of Law Examiners that I no longer meet the requirements of Order No. 837, I shall so notify my supervising attorney within one business day.

I verify that the statements of fact made by me in this declaration are true and correct and that they are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. I further verify that I have not omitted any facts or matters material to the matters set forth in this declaration or to the requirements of Order No. 837.

Applicant Signature:

Date:	Date Signed