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OFFICE OF ATTORNEY LICENSING 32 CHERRY STREET, SUITE (Vermont Judiciary)

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900-00028 - Intern Appearance Permission (State Agency) (10/2019) Page 1 of 1
PERMISSION FOR LEGAL INTERN TO APPEAR AS LEGAL COUNSEL
ON BEHALF OF STATE AGENCY
Unit: Division:
Legal Intern’s Name
(please print): ___________________________________
Jurisdictions Currently Licensed in: _________________________________
Consent and Certification of the Supervising Attorney
I hereby consent to the appearance of the Legal Intern named above to appear as legal counsel before the Court on
behalf of the following state government agency: ___________________________________. I certify that I have
complied with, and will continue to comply with, the Rules of Admission to the Bar of the Vermont Supreme Court as
they apply to the appearance of the Legal Intern in this Court on behalf this agency, including the duties of supervision.
Date: _____________ Attorney’s Signature: _____________________________________
Attorney’s Printed Name: __________________________________
Certification and Agreement of the Legal Intern
I certify that I have complied with, and will continue to comply with, the Rules of Admission to the Bar of the Vermont
Supreme Court as they apply to my appearance as legal counsel in this Court on behalf of the state government agency
named above.
I hereby agree to be bound by the Vermont Rules of Professional Conduct.
Date: _____________ Signature: _____________________________________
Permission of the Court
The Legal Intern named above is hereby granted permission to appear as legal counsel in this Court on behalf of the
state government agency named above. The Legal Intern is hereby authorized to conduct the activities of a legal intern
as specified in the Rules of Admission to the Bar of the Vermont Supreme Court in compliance with the conditions
specified in those Rules.
Date: _____________ Signature: _____________________________________
Questions regarding legal intern eligibility should be directed to the Office of Attorney Licensing at (802) 859-3000.
V
ERMONT
S
UPREME
C
OURT
OFFICE OF ATTORNEY LICENSING
32 CHERRY STREET, SUITE 213
BURLINGTON, VT 05401
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OFFICE OF ATTORNEY LICENSING 32 CHERRY STREET, SUITE (Vermont Judiciary)

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Completed 30 July 2020

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