Fillable NORTHCAROLINASTATEBAR PRACTICALTRAININGOFLAWSTUDENTS/CLINICALLEGALEDUCATIONPROGRAMS SUPERVISINGATTORNEYSTATEMENT(LAWSCHOOLCLINIC)FormDate:October29,2019 27N.C.Admin.Code1C,Sect..0200 [Date] [nameofcli

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NORTHCAROLINASTATEBAR PRACTICALTRAININGOFLAWSTUDENTS/CLINICALLEGALEDUCATIONPROGRAMS SUPERVISINGATTORNEYSTATEMENT(LAWSCHOOLCLINIC)FormDate:October29,2019 27N.C.Admin.Code1C,Sect..0200 [Date] [nameofclinic] [nameofschool] (North Carolina State Bar)

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The NORTHCAROLINASTATEBAR PRACTICALTRAININGOFLAWSTUDENTS/CLINICALLEGALEDUCATIONPROGRAMS SUPERVISINGATTORNEYSTATEMENT(LAWSCHOOLCLINIC)FormDate:October29,2019 27N.C.Admin.Code1C,Sect..0200 [Date] [nameofcli form is 1 page long and contains:

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NORTHCAROLINASTATEBAR
PRACTICALTRAININGOFLAWSTUDENTS/CLINICALLEGALEDUCATIONPROGRAMS
SUPERVISINGATTORNEYSTATEMENT(LAWSCHOOLCLINIC)FormDate:October29,2019
27N.C.Admin.Code1C,Sect..0200 
_____________________________
[Date]
Iamasupervisingattorneyforthe__________________________________________________at
[nameofclinic]

________________________________________.PursuanttotheNorthCarolinaStateBar’sRules
[nameofschool]
GoverningthePracticalTrainingofLawStudents,27N.C.Admin.Code1C,Section.0200(theRules),I

assumeresponsibilityforthesupervisionofthelawstudentslistedbelowwhiletheyarelegalinterns
andenrolledintheclinicfor_________________________________andcertifythatIwilladequately
[stateperiodofsupervision]
supervisethelegalinternsinaccordancewiththeRules.[printstudentnamesbeloworattachlist]
_____________________ _____________________ _____________________
_____________________ _____________________ _____________________
_____________________ ______________________ _____________________
_______________________________ ___________________
[Signature][Date]
_______________________________ ___________________
[PrintName][Title]

__________________________________________________________
[LawSchool]
___________________________________________________________
[MailingAddress]
Returnformto:StudentPracticeForms@NCBar.gov
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NORTHCAROLINASTATEBAR PRACTICALTRAININGOFLAWSTUDENTSCLINICALLEGALEDUCATIONPROGRAMS SUPERVISINGATTORNEYSTATEMENT(LAWSCHOOLCLINIC)FormDate:October29,2019 27N.C.Admin.Code1C,Sect..0200 Date nameofclinic nameofschool (North Carolina State Bar)

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Completed 20 July 2020

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