Supreme Court of Pennsylvania 
Application for Committee / Board Membership 

In order to foster wider participation in the judicial system, the Supreme Court encourages 
applicants with appropriate training, experience, and interest to apply. For attorney positions, the 
Court ordinarily considers applicants with at least seven years of relevant experience.   

All applications will be retained for two years. In the event that additional positions become open 
on the committee or board for which an application was submitted, those retained applications 
will be considered for those openings within the two-year period. 

The application requires applicants to answer whether criminal charges or formal charges of 
professional misconduct have ever been filed against the applicant. Applicants must inform the 
Court if there are any changes to that answer during the two-year retention period. Applicants 
should submit that information through the same address used to file the application. 

This application is fillable. The form may be printed and scanned for email 
transmissionor saved as an attachment and emailed. When completed, email 
the application, letter of interest, your resume and other information you 
believe may be helpful in assessing your qualifications. 
Send the email to: SCApplications@pacourts.us 

If you are unable to send documents via email, send them to: 
AOPC, Advisory Board Membership, ATTN: Diane C. Bowser, 
1515 Market St., Suite 1414, Philadelphia, PA 19102 

Name (Please print) 

Attorney I.D. No. (if applicable) 

Home Address 

City        

          State      

  Zip    

 County 

I
your home address is outside of Pennsylvania, is your practice of law or other business 
 
f
conducted principally in Pennsylvania?  

Yes 

No 

Employer 

Title 

 Address of Principal Place of Business 

 County 

       Preferred Telephone Number 

 Preferred Email Address 

Page 1 of 5Vacancy of Interest and Application Deadline: 

1. 

2. 

3. 

4. 

List of Attachments: 

      Letter of Interest 
      Application 
      Resume 

Other Pertinent Information (if any)

 ____________________________            Applicant Name Page 2 of 5References (Professional or personal):

Relationship to you 

1. 

Name 

2. 

Name 

Relationship to you 

 3.   
      Name      

     Relationship to you 

Telephone 

Position/Title 

Telephone 

Position/Title 

Telephone       Position/Title 

Are you currently serving on any Pennsylvania Supreme Court Committees, boards, advisory 
groups or independent judicial-related entries?  

Yes 

No 

If yes, please list: _______________________________________ 

 ____________________________            Applicant Name Page 3 of 5Affirmation of Eligibility 

Have any criminal charges (felony or misdemeanor) or formal charges of professional misconduct 
ever been filed against you?  

If yes, please explain in a separate document 

Do you have any conflicts of interest that would prevent you from impartially discharging your 
duties as a member of a Supreme Court Committee or Board?  

If yes, please explain in a separate document 

I certify that the facts contained herein are true and correct to the best of my knowledge. I 
authorize investigation of all statements contained in this application, which may include a 
criminal background check pursuant to 18 Pa.C.S. § 9101 et seq. 

Signature: 

Date: 

Yes 

No 

Yes 

No 

 ____________________________            Applicant Name Page 4 of 5Diversity Information (Optional) 

The Supreme Court of Pennsylvania is committed to ensuring diversity in its appointments. 
Therefore, if you choose, we ask that you provide us with information to help us to achieve 
this goal. 

Race/Ethnicity (check one) 

Hispanic/Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other 

Spanish culture or origin regardless of race. 

 White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, 

 Black/African American (Not Hispanic or Latino): A person having origins in any black racial 

North Africa, or the Middle East. 

groups of Africa. 

 Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far 

East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, 
India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. 

 American Indian or Alaska Native (Not Hispanic or Latino): A person having origins in any of the 
original peoples of North and South America (including Central America), and who 

maintains tribal affiliation or community attachment. 

 Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having origins in any 

of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.  

Two or More Races: All persons who identify with more than one of the above races. 

Other

  Female 

Male 

Gender Identity (check one) 

 ____________________________            Applicant Name Page 5 of 5