Professional Misconduct Cases & Grievance Defense
GRIEVANCE FORM
PART A: INFORMATION ABOUT YOU - PLEASE KEEP CURRENT
It is necessary in order to timely process your grievance that all information
be typed or printed legibly.
1. NAME:
___________________________________________________
LAST FIRST MIDDLE MAIDEN
2.
MAILING ADDRESS: _______________________________________
CITY:
________ STATE: ________ ZIP:_________ PHONE:________
3.
EMPLOYER: ______________________________________________
4. WORK
ADDRESS: _________________________________________
WORK
PHONE: ___________________________________________
5. MAY WE
CONTACT YOU AT YOUR EMPLOYMENT YES__ NO___
6.
DRIVERS LICENSE # __________ DATE OF BIRTH ___________
7. NAME,
ADDRESS AND PHONE NUMBER of person not in your
household who can always reach you.
NAME:
_________________________________________________
ADDRESS: _____________________________ PHONE: _________
8. Are
you represented by an attorney now? If so, please provide:
NAME:
_________________________________________________
ADDRESS:
_____________________________ PHONE: __________
9. How
did you hear about the grievance process: (Check One)
____Attorney in Complaint _____1-800# _______ Another Attorney
____Brochure in Courthouse _____Phone Book _______ Other
10. Do
you understand and write in the English language? Y / N
If no,
what is your primary language? _______________________
Who
helped you prepare this form? _______________________
Will
they be available to translate future correspondence
during
this process? Yes/No
IF ANY OF
THE ABOVE INFORMATION SHOULD CHANGE IT IS NECESSARY THAT YOU ADVISE THE STATE BAR OF TEXAS IN WRITING IMMEDIATELY. PLEASE DO NOT WRITE ON THE BACK
OF ANY PAGES OF THIS COMPLAINT FORM. USE ADDITIONAL PAPER IF NECESSARY.
PLEASE WRITE ON ONE SIDE ONLY.
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