Application for Admission Credit Report Information Form

Please complete the following form as part of your Application for Admission to the State Bar of Nevada. Complete a separate form for each account in question. Make additional copies of the form if needed. Answer and complete all items on this form. If an item requiring your response is not applicable, write “N/A”. Use separate sheets if more space is needed. This form is to be completed honestly and to the best of your knowledge after reasonable inquiry. If you are unaware of the debt, please obtain a copy of your Transunion credit report to review the account. Please provide all required documentation for the account listed. All applicants must provide proof that each account in question has either (a) been paid; (b) that payment arrangements have been made; or (c) that the debt is currently under dispute. This proof may include account statements, letters from the creditor or lender, internet account printouts, etc.

Email*

Enter email to receive submission confirmation with copy of Application for Admission Credit Report Information Form
Name*

First Middle Last
Name of Creditor or Lender*
Address of Creditor or Lender*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number(s):*
Date of initial delinquent account(s):*
Describe the nature of the obligation(s) and reason for arrearage:*
Total Current Amount Due, Outstanding, Owed or Unpaid:*
Has the account been sent to collections?*
- Yes
- No
Have you made or plan to make payments or payment arrangements?*
- Yes
- No
Is the account currently under dispute?*
- Yes
- No
Current Status of the obligation(s) such as past due, current on payments, deferment, forbearance, etc.:*
If you are currently unable to make payments or payment arrangements, please provide an explanation:*
Attach Relevant Files*
Drop files here or

Max. file size: 100 MB.