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

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900-00029 - Intern Appearance Permission (Not State Agency) (10/2019) Page 1 of 1
STATE OF VERMONT
SUPERIOR COURT
DIVISION
Unit
Docket No.:
Plaintiff
vs.
Defendant
CONSENT AND PERMISSION FOR LEGAL INTERN
TO APPEAR AS LEGAL COUNSEL
Legal Intern’s Name (please print): _______________________________________
Jurisdictions Currently Licensed in: _____________________________________
Consent of the Client
I hereby consent to the appearance of the Legal Intern named above to appear as legal counsel on my behalf before
the Court in the matter referenced above in accordance with the Rules of Admission to the Bar of the Vermont
Supreme Court.
Date: _____________ Client’s Signature: _____________________________________
Client’s Printed Name: __________________________________
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 in
this matter on behalf of the Client named above. 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 matter, including the duties of supervision.
I also certify that I have in force professional liability
insurance that will cover the actions of the Legal Intern in this matter.
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 matter.
I hereby agree to be bound in this matter
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 matter on behalf of the
Client named above. The Legal Intern is hereby authorized to conduct in this matter 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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