Name Bar Number Firm Name Address Office Phone Mobile Phone Email Address Fax Apply for: Felonies of the 4th and 5th degree and unclassified felonies other than aggravated murder and murder Completed 12 hours CLE in criminal practice and procedure – 4th/5th degree At least one year experience in criminal law – 4th/5th degree Apply for: Felonies of the 3rd degree Completed 12 hours CLE in criminal practice and procedure – 3rd degree At least one year experience in criminal law – 3rd degree Trial counsel in at least one criminal jury trial within 10 years – 3rd degree Apply for: Felonies of the 1st and 2nd degree Completed 12 hours CLE in criminal practice and procedure – 1st/2nd degree Trial counsel in two criminal jury trials at least one as lead counsel – 1st/2nd degree Apply for: OVI Certification Completed six hours CLE focused on OVI practice and procedure

Apply for: Juvenile bindover cases Meet requirements of OAC 120-1-10(M) for juvenile cases Juvenile case levels I qualify for Apply for: Aggravated murder without death penalty, murder, and life sentence cases Completed 12 hours CLE in criminal practice and procedure – aggravated murder At least five years experience in criminal law Lead counsel in three jury trials at least two felonies within 10 years Apply for: Death specification cases Certified by Ohio Supreme Court Commission on Appointment of Counsel in Capital Cases Lead counsel experience waiver Completed 30-hour trial training program within prior 10 years Other courts for which I serve on the criminal court-appointed counsel list

Counsel type requested — select one

As trial counsel only

As appellate counsel only

As both trial counsel and appellate counsel

Applicant Signature Date (Applicant) Administrative Judge Approval Date (Administrative Judge)