Certification of Completion
of the
CLE Requirements of Rule 12(a)(1) and Rule 15(c)
Contact Information
1. Last name:
2. First name:
3. Attorney License Number:
4. Email address:
Check one:
___ I was admitted to the Bar of the Vermont Supreme Court by examination or transferred UBE score and thus
must comply with the requirements of Rule 12(a)(1) of the Rules of Admission to the Bar of the Vermont
Supreme Court.
___ I was admitted to the Bar of the Vermont Supreme Court without examination and thus must comply with
the requirements of Rule 15(c) of the Rules of Admission to the Bar of the Vermont Supreme Court.
By signing and submitting this form, I understand that I am certifying each of the following:
• I completed 15 hours of CLE of Vermont practice and procedure in courses approved by the Board of
Continuing Legal Education and certified by the Board of Bar Examiners as satisfying the requirements of
Rule 12(a)(1) and Rule 15(c) of the Rules of Admission to the Bar of the Vermont Supreme Court.
• I earned at least 6 of those 15 hours by attendance at live courses.
• I completed the 15 hours of CLE no earlier than:
o 6 months before I sat for the bar exam (for attorneys admitted by examination or transferred UBE
score); or
o 1 year before admission to the Bar of the Vermont Supreme Court (for attorneys admitted without
examination).
• I completed the 15 hours of CLE no later than 1 year after I was admitted to the Bar of the Vermont
Supreme Court.
• I will keep records demonstrating compliance for two years from the date of signing this form and make
them available to the Office of Attorney Licensing upon request.
• I understand that I am submitting this form in connection with my application for admission to the Bar of
the Vermont Supreme Court and subject to the provisions of the Vermont Rules of Professional Conduct,
including Rule 8.1(a).
Date: _______________________________
Signature: _______________________________
ERMONT
UPREME
OURT
OFFICE OF THE STATE COURT ADMINISTRATOR
OFFICE OF ATTORNEY LICENSING
900-00005 – Certification of Compliance with Rule 12(a)(1) and Rule 15(c) CLE (08/2017) Page 1 of 1