INSTRUCTIONS FOR FORM 5

In the boxes provided on the first page of Form 5, type your name, correspondence and email addresses. DO NOT WRITE IN THE REMAINDER OF THE FIRST PAGE OF FORM 5. Complete the second page of Form 5 by listing the NAME of each personal reference and the name of each employer reference and your supervisor. (See the instructions for Forms 10 & 11 for exceptions.) Return both pages of Form 5 with your application. Important notice: If you pass the July 2019 bar examination, you must complete your application by April 30, 2020, or your application will be deemed to be withdrawn and you will have to apply for, retake, and pass the bar examination again. (See Article IX for details.)

Form 5 JULY 19

1

July 2019 Connecticut Bar Examination Application Status Sheet

__________ ___________ __________ ___________ __________ ___________ __________ ___________ __________ ___________

Your name and correspondence address

Notify the Committee if your mailing or email address has changed.

All items shown as not received below are required to complete your application. These items (except as otherwise noted below) must be received by the Bar Examining Committee by September 23, 2019, or your recommendation for admission may be delayed. You will not receive notification of your examination site assignment until your Form 4 and law school final transcript have been received. The bar results will be posted at Noon on September 27, 2019, on www.jud.ct.gov/CBEC/. If you pass the July 2019 bar exam, you must complete your application by April 30, 2020, or it will be deemed to be withdrawn (see Art IX).

Email NOT Received Received __________ [X] Application (signed and notarized) __________ [ ] [ ] NCBE Number (due by 24 July 2019) __________ [ ] [ ] Official final transcript (_________________________) __________ [ ] [ ] Official final transcript (_________________________) __________ [ ] [ ] Official final transcript (_________________________) __________ [ ] [ ] Certificate of dean of law school (due by 24 July 2019) __________ [ ] [ ] Official, final law school transcript (due by 24 July 2019) __________ [ ] [ ] Official LL.M. course descriptions (foreign educated applicants only) __________ [ ] [ ] Law school application __________ [ ] [ ] MPRE _______/_______ or Course _______/_______ __________ [ ] [ ] Bar applications: [ ]_______ [ ]_______ [ ]_______ __________ [ ]_______ [ ]_______ [ ]_______ [ ]_______ __________ [ ] [ ] Good standing certificates: [ ]_______ [ ]_______ __________ [ ]_______ [ ]_______ [ ]_______ [ ]_______ __________ [ ] [ ] Certified driving histories: [ ]____ [ ]____ [ ]____ __________ [ ]____ [ ]____ [ ]____ [ ]____ [ ]____ [ ]____ __________ [ ] [ ] Military separation (DD214) __________ [ ] [ ] Military Service Form 26A __________ [ ] [ ] Litigation _________________________________ __________ [ ] [ ] Credit issues________________________________ __________ [ ] [ ] Personal reference letters Form 10 (see over) __________ [ ] [ ] Employer reference letters Form 11 (see over) __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________ __________ [ ] [ ] Other:_____________________________________

---------------------------------------------CBEC USE ONLY--------------------------------------------- __________ [ ] [ ] AKA:____________________ From:_____ To:_____ __________ [ ] [ ] Credit report

Form 5 JULY 19

2

Name: List below your personal and employer references as listed in Questions 13 and 17 of your bar application. This form will be used to keep you informed of which reference letters have been received. Do not list below military service, self-employment, unpaid employment for academic credit, or employment from more than five years ago. Rec’d

Question 13: Personal references:

[ ] 1.

[ ] 2.

[ ] 3.

Question 17: Employer references:

None. Explain: ________________________________________________

________________________________________________

Employer Supervisor [ ] 1.

[ ] 2.

[ ] 3.

[ ] 4.

[ ] 5.

[ ] 6.

[ ] 7.

[ ] 8.

[ ] 9.

[ ] 10.

[ ] 11.

[ ] 12.

[ ] 13.

[ ] 14.

[ ] 15.

[ ] 16.

[ ] 17.

[ ] 18.

[ ] 19.

[ ] 20.

[ ] 21.

[ ] 22.