UNITED STATES DISTRICT COURT

CENTRAL DISTRICT OF CALIFORNIA

Plaintiff(s)

v.

Defendant(s).	CASE NUMBER:

(PROPOSED) ORDER ON APPLICATION

OF REGISTERED LEGAL SERVICES ATTORNEY TO PRACTICE BEFORE THE COURT
The Court, having reviewed the Application of Registered Legal Services Attorney to Practice Before the Court filed by
of

Applicant's Name (Last Name, First Name & Middle Initial)

Telephone Number	Fax Number	Cal. State Bar No.
E-Mail Address	Qualifying Legal Services Provider Name & Address
for permission to appear and participate in this case on behalf of

Name(s) of Party(ies) Represented	□ Plaintiff	□ Defendant	□ Other:

and designating as Supervising Attorney
of

Designee's Name (Last Name, First Name & Middle Initial)

Telephone Number	Fax Number	Cal. State Bar No.

E-Mail Address

hereby ORDERS the Application be:

□ GRANTED.

□ DENIED.	Qualifying Legal Services Provider Name & Address

Dated

U.S. District Judge/U.S. Magistrate Judge