U.S. District Court 
District of Massachusetts 

CJA Supplemental Habeas Panel Application

	The following application should be completed by attorneys requesting appointment to the CJA list of individuals eligible to represent indigent petitioners seeking relief in the United States District Court pursuant to 28 U.S.C. §§ 2254 and 2255, the habeas corpus statutes.  In addition, counsel who are not current members of one of the CJA panels for the District of Massachusetts should complete the general CJA Panel Application.

	Please note the instructions on the Court’s website for downloading and completing this application, including that the answers must be typewritten.

1.	Full Name:

2.	Please identify the five (5) most recent habeas cases that you have handled, including the name, docket number, judge and counsel involved, nature of case, and whether you were lead counsel or second chair.  Please include current phone numbers of the lawyers.

	RESPONSE:

3.	Please identify the five (5) most recent federal habeas appeals you have handled, including the name, docket number, judge and counsel involved, nature of case, and whether you were lead counsel or second chair.  Please include current phone numbers of the lawyers.

	RESPONSE:

4.	Please identify the five (5) most recent federal criminal appeals you have handled, including the name, docket number, judge and counsel involved, nature of case, and whether you were lead counsel or second chair.  Please include current phone numbers of the lawyers.

	RESPONSE:

5.	Please identify the five (5) most recent state criminal appeals you have handled, including the name, docket number, judge and counsel involved, nature of case, and whether you were lead counsel or second chair.  Please include current phone numbers of the lawyers.

	RESPONSE:

6.	Please describe what training programs you have attended in the fields of habeas corpus law, federal criminal appeals, and post-conviction litigation.

	RESPONSE:

7.	Please attach (as a tabbed Appendix 1) one example of a brief, memorandum of law, or similar example of legal writing not to exceed fifteen pages - which was prepared solely by you within the past five years. If you do not have a sample of this length, please include an excerpt from a longer document. Do not exceed the fifteen-page limit. The Board’s preference is for a document which relates to a federal habeas case.

8.	Please furnish whatever other information you would like the Board to consider.

	I hereby certify that the above information is true and correct.

Date: ______________________			__________________________
							Applicant’s Signature

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