900-00028 - Intern Appearance Permission (State Agency) (01/2018) Page 1 of 1
PERMISSION FOR LEGAL INTERN TO APPEAR AS LEGAL COUNSEL
ON BEHALF OF STATE AGENCY
Legal Intern’s Name (please print): ____________________________________________________
Unit:
Division:
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 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.
☐ I do ☐ I do not
authorize the Legal Intern to appear without the Supervising Attorney at court
appearances not involving a contested matter.
Date: _____________ Signature: _____________________________________
Questions regarding an Intern's eligibility should be directed to the Office of Attorney Licensing at (802) 859-3000.
VERMONT SUPREME COURT
OFFICE OF ATTORNEY LICENSING
32 CHERRY STREET, SUITE 213
BURLINGTON, VT 05401
JUD.ATTYLICENSING@VERMONT.GOV
