Fillable NORTHCAROLINASTATEBAR PRACTICALTRAININGOFLAWSTUDENTS/CLINICALLEGALEDUCATIONPROGRAMS FIELDPLACEMENTSITESUPERVISORSTATEMENTFormDate:October29,2019 27N.C.Admin.Code1C,Sect..0200 [Date] [locationoffieldpl

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NORTHCAROLINASTATEBAR PRACTICALTRAININGOFLAWSTUDENTS/CLINICALLEGALEDUCATIONPROGRAMS FIELDPLACEMENTSITESUPERVISORSTATEMENTFormDate:October29,2019 27N.C.Admin.Code1C,Sect..0200 [Date] [locationoffieldplacement] [nameoflawschool] (North Carolina State Bar)

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NORTHCAROLINASTATEBAR
PRACTICALTRAININGOFLAWSTUDENTS/CLINICALLEGALEDUCATIONPROGRAMS
FIELDPLACEMENTSITESUPERVISORSTATEMENTFormDate:October29,2019
27N.C.Admin.Code1C,Sect..0200
_____________________________
[Date]
Iamthesitesupervisorforafieldplacementat___________________________________.Thefield
[locationoffieldplacement]
placementisapartoftheclinicallegaleducationprogramat_______________________________.
[nameoflawschool]
PursuanttotheNorthCarolinaStateBar’sRulesGoverningthePracticalTrainingofLawStudents,27
N.C.Admin.Code1C,Section.0200(theRules),Iassumeresponsibilityfortheadministrationofthe
fieldplacementincompliancewiththeRules.Thelawstudentslistedbelowwillparticipateinthefield
placementfor________________________.Thelawstudentswillbesupervisedbythefollowing
[stateperiodofsupervision]
supervisingattorney(s):_______________________________________________________________.
[listsupervisingattorney(s)includingsitesupervisorifappropriate]

Icertifythatthesesupervisingattorneyswilladequatelysupervisethelegalinternsinaccordancewith
theRules.[printstudentnamesbeloworattachlist]
_____________________ _____________________ _____________________
_____________________ _____________________ _____________________
_____________________ _____________________ _____________________
_______________________________ ___________________
[Signature][Date]
_______________________________ ___________________
[PrintName][BarNumber]

___________________________________________________
[MailingAddress]

Returnformto:StudentPracticeForms@NCBar.gov
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NORTHCAROLINASTATEBAR PRACTICALTRAININGOFLAWSTUDENTSCLINICALLEGALEDUCATIONPROGRAMS FIELDPLACEMENTSITESUPERVISORSTATEMENTFormDate:October29,2019 27N.C.Admin.Code1C,Sect..0200 Date locationoffieldplacement nameoflawschool (North Carolina State Bar)

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Completed 20 July 2020

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