| Today's Date | |
| 1. Name | |
| 2. Email Address | |
| 3. Gender | |
| 4. Age | |
5. Legal Education:
University | |
| Law School [if different] | |
| 6. Current Position [Please list Court and Full Title | |
| 7. Court | |
| 8. Street Address | |
| 9. City | |
| 10. State [if applicable] | |
| 11. Zip/Postal Code | |
| 12. Country | |
| 13. Years on Bench | |
| 14. Years in Practice, before becoming a judge | |
15. If you answered #9 please indicate for those years in practice, practice areas:
ctrl-click to select multiple | |
| 16. Official Title | |
| 17. Please describe the level court over which you preside: | |
| 18. My Court is grounded in the: | |
| 19. Your Court's primary area of Jurisdiction | |
| 20. Dates on Bench | |
21. International Field Experience
tick box if "yes" | |
| 22. If yes, please describe | |
| 23. Please describe your training experience, if any | |
24. Have you participated in a NITA (National Institute of Trial Advocacy) training, as a trainer or trainee, at any time?
tick box if "yes" | |
| 25. If your answer to the above is in the affirmative, please provide details: dates, subject matter etc. | |
26. Please select all languages in which you are fluent
ctrl-click to select multiple | |
27. Please select any country other than your current resident address where you have lived or worked for any meaningful length of time
ctrl-click to select multiple | |
28. Which choice best describes your internet/computer level
ctrl-click to select multiple | |
29. Select the item that best describes your email access
ctrl-click to select multiple | |
30. Do you own a laptop?
tick box if "yes" | |
31. I am interested in working with LWOB or learning more about the following
ctrl-click to select multiple | |
| If other, please describe | |
32. I am able to self fund all or a significant portion of my involvement in any activity described in #26 above.
tick box if "yes" | |
| 33. If there is any qualification or other matter not raised in this form, please feel free to discuss same in the comments box | |
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