Notice Of Additional Or Change Of Employing Agency-Supervising Attorney

NOTICE OF ADDITIONAL OR CHANGE OF EMPLOYING AGENCY/SUPERVISING ATTORNEY ILLINOIS SUPREME COURT RULE 711 To: Administrative Office of the Illinois Courts th 222 North LaSalle Street, 13 Floor Chicago, Illinois, 60601 The services authorized by Illinois Supreme Court Rule 711, which I acknowledge Ihave read, will be performed by me for: ______________________________________________________________________________ Full Name of Agency ____________________________________________________________________________________________ Agency Address City/State/Zip Code ( ) ____________________________________________________________________________________________ Agency Telephone Number Supervising Attorneys Name (Must be a member in good standing of the Illinois Bar)The Agency indicated above is (check appropriate box): ? A legal aid bureau, legal assistance program, organization or clinic chartered by the State of Illinois or approved by a law school approved by the American Bar Association ? The Office of the Public Defender ? A law office of the state or any of its subdivisions_________________________________ Dated this ______ day of _______________, 20 _____ Supervising Attorneys Signature For office use only:_______________________________________ Law School Students Signature Approved by: _______________ Date: ________Name: ________________________________ Address:________________________________ ________________________________ Telephone: ______________________________ 711 License number: ______________________