Managed Assigned Counsel Application (New Attorney)

Use this form to make your initial application to a Managed Assigned Counsel Roster (MAC Roster). If you already are on a MAC Roster but want to be considered for different/ additional roster(s), you should use the Managed Assigned Counsel Application (Existing Attorney).

Name

First Middle Last

Licensure

I am licensed to practice law in North Carolina

Year Licensed

State Bar Number

Firm or Employer Name

Use "self" if self-employed

Address

Street Address Address Line 2 City ZIP / Postal Code

Cell Phone

Office Phone

Website

I have a confidential place in which to meet clients and will be available for meetings on a reasonable basis.

Yes

Describe Space

I would like to apply for the following MAC Rosters:

List 1: Misdemeanor Cases and Misdemeanor Probation Violations

List 2: Felonies F through I and Felony Probation Violations

List 3: Felonies A to E

List 4A: Juvenile Cases A1-3 Misdemeanors, Class H-I Felonies, Probation Violations, and Motions for Contempt

List 4B: Juvenile Cases A - G Felonies

List 5C: Civil Commitment

List 7: Parent Representation

I would like to apply to the selected rosters in the following counties:

Preferred Counties

Preferred Rosters

I have practiced adult criminal law on a consistent basis for ____ years.

I have served as first chair in ____ jury trials that went to verdict.

I have served as second chair in ____ jury trials that went to verdict.

I have participated as trial counsel in at least one case involving a charge covered by List 3 (Class A through E Felonies).

Yes

I observed the following district court criminal sessions:

District

Judge

Date

Use "+" icon to the right of date to add additional fields. Must list at least three separate sessions.

I have attended at least three (3) hours of continuing legal education (“CLE”) in the area of criminal law within the past year (specify date(s), program(s), and sponsor(s) below):

Date

Program

Sponsor

Hours

Use "+" icon to the right of date to add additional fields. Must list at least three separate educational programs.

I have practiced juvenile delinquency law on a consistent basis for ____ years.

I have shadowed an attorney currently on List 4A for two (2) court sessions.

Attorney Name

Date

Use "+" icon to the right of date to add additional name and session.

Parental Rights

I have practiced parental rights law on a consistent basis for ____ years.

I have attended at least three (3) hours of continuing legal education (“CLE”) in the area of parental rights within the past year (specify date(s), program(s), and sponsor(s) below):

Date

Program

Sponsor

Hours

Use "+" icon to the right of date to add additional fields. Must list at least three separate educational programs.

I observed the following Chapter 7B, Subchapter 1 hearings:

Non-secure Custody Hearing

District

Judge

Date

Contested Adjudication Hearing

District

Judge

Date

Permanency Planning Review Hearing

District

Judge

Date

Review Hearing

District

Judge

Date

Contested termination of parental rights hearing

Observation of a contested termination of parental rights hearing was not possible.

I observed the contested termination parental rights hearing described below.

Contested Termination of Parental Rights Hearing

District

Judge

Date

Request for Waiver

I am requesting a waiver and agree to the following:

I acknowledge that I do not meet the minimum qualifications for below indicated list to which I have applied. I understand that IDS may still elect to enter into a service contract with me but that the contract may include additional requirements as deemed appropriate by IDS.

Attachments

If you are submitting materials in addition to the required certifications, please complete the following section:

I have attached the following additional material that may IDS in evaluating my trial qualifications and experience, including relevant law school clinical or other skill-building experience as an alternative for any list that requires a number of years of required practice as a qualification:

File

Max. file size: 50 MB.

File

Max. file size: 50 MB.

File

Max. file size: 50 MB.

File

Max. file size: 50 MB.

Acknowledgment

I agree to the following:

I the undersigned, certify that I have given true, accurate, and complete information on this application to the best of my knowledge.

I authorize Indigent Defense Services to investigate all information provided in this application and supporting submissions.

I understand that false information, false documentation, or a failure to disclose relevant information may be grounds for rejection of my application.

I consent to a confidential inquiry by Indigent Defense Services of the contacts listed in this application, if any, and others familiar with my competence, for the purpose of determining whether I fulfill the requirements to be placed on the roster of attorneys eligible for appointment for the lists on which I have requested placement.

I further understand that all information received by Indigent Defense Services in conjunction with this application, including reference information, shall be confidential and available for use only by Indigent Defense Services and shall not be disclosed except as required by law. By submitting this application, I explicitly waive the right to review reference information obtained by IDS.

I have read the Regulations for Appointment of Contract Counsel in Cases under the Indigent Defense Services Act, and I agree to abide by the rules and conditions of appointment set forth there.

Signature