The State Bar of California
Office of Admissions
180 Howard Street · San Francisco, CA 94105
(415) 538-2117 - PTLS@calbar.ca.gov
Practical Training of Law Students Program
Declaration by Supervising Attorney
(APPLICATIONS MUST BE TYPEWRITTEN OR LEGIBLY PRINTED IN INK.)
1. SUPERVISING ATTORNEY INFORMATION
Attorney Name: State Bar Number:
Employer Name:
PTLS Supervising Attorney Declaration.0915
Address:
City: State: Zip:
Phone: Fax: Email:
Expected Period of Supervision: Through:
2. STUDENT INFORMATION
This student has been previously certified. Submit only this form.
This student has never been certified. Submit this form along with a student application packet.
Student Name/Home Address:
Student Email Address:
3. DECLARATION
I declare under penalty of perjury under the laws of the State of California that the following is true and correct:
I am an active member of the State Bar of California and have practiced law or taught law in a law school as a full-time
occupation for at least two years.
I will supervise no more than 5 Certified Students concurrently unless I am employed full-time to supervise law students as
part of an organized law school or government agency training program in which case I will supervise no more than 25
Certified Students.
I will assume personal professional responsibility for any work performed by the Certified Student while under my supervision.
I will assist and counsel the Certified Student in the activities authorized by the rules and review such activities with the
Certified Student to the extent required for the proper practical training of the Certified Student and the protection of the client.
I will read, approve and personally sign any pleadings, briefs or other similar documents prepared by the Certified Student
prior to filing thereof, and read and approve any documents which shall be prepared by the Certified Student for execution by
any person who is not a member of the State Bar of California prior to submission thereof for execution. I understand that
exclusively in the case of government agencies, a Designated Attorney may, in my place, perform the obligation set forth
above, but I shall still provide general supervision.
I will provide the level of supervision to the Certified Student required by the Rules of the State Bar of California, Title 3,
Division 1, Chapter 1, Rule 3.4.
I will promptly notify the State Bar in writing if my supervision of the Certified Student ends prior to the date indicated on the
Notice of Certification.
I have read and am familiar with the Rules of Professional Conduct of the State Bar of California and I will abide by them in
the activities permitted by California Rules of Court, Rule 9.42 Certified Law Students.
Executed On: Signature:
Print Name:
