2024 Summer Session Scholarship Application Form

Your Name *

Address *

City/State/ZIP *

State Bar Number

Phone

Fax

Email

Number of years in law practice

Number of years in NCDD

Approximate number of DUI/DWI jury and non-jury trials you have handled

Have you ever been arrested for any crime? If YES, please explain and provide the final disposition of the case including whether or not you received a “deferred” or “diverted” disposition.

A. Has your Bar Association or licensing authority conducted any investigation or inquiry of you based upon complaints?
B. Have you ever been subject to disciplinary action by your bar association or licensing authority?
C. Has your license to practice law ever been suspended or revoked for any period of time?

If your answer to any portion of questions above is in the affirmative, please explain:

Are you presently serving, in any capacity, (either part time or full time) in a law enforcement or prosecution agency (Example, reserve duty officer or municipal prosecutor)? If YES, please explain:

Please explain your reasons for requesting the scholarship: *