Applicant Name

* indicates required fields.

First Name *


Middle Name


Last Name *

Professional Contact info to be listed on public Statewide Roster

Phone *
Please use this format : 303-123-4567

Email Address*


Address *


Address Line 2


City *


State *
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ZIP Code *

Districts

Mark all districts you will accept appointments in.

	All Districts
	1st Judicial District	Gilpin, Jefferson
	2nd Judicial District	Denver
	3rd Judicial District	Huerfano, Las Animas
	4th Judicial District	El Paso, Teller
	5th Judicial District	Clear Creek, Eagle, Lake, Summit
	6th Judicial District	Archuleta, La Plata, San Juan
	7th Judicial District	Delta, Gunnison, Hinsdale, Montrose, Ouray, San Miguel
	8th Judicial District	Jackson, Larimer
	9th Judicial District	Garfield, Pitkin, Rio Blanco
	10th Judicial District	Pueblo
	11th Judicial District	Chaffee, Custer, Fremont, Park
	12th Judicial District	Alamosa, Conejos, Costilla, Mineral, Rio Grande, Saguache
	13th Judicial District	Kit Carson, Logan, Morgan, Phillips, Sedgwick, Washington, Yuma
	14th Judicial District	Grand, Moffat, Routt
	15th Judicial District	Baca, Cheyenne, Kiowa, Prowers
	16th Judicial District	Bent, Crowley, Otero
	17th Judicial District	Adams, Broomfield
	18th Judicial District	Arapahoe, Douglas, Elbert, Lincoln
	19th Judicial District	Weld
	20th Judicial District	Boulder
	21st Judicial District	Mesa
	22nd Judicial District	Dolores, Montezuma