900-00011 – Supervisor’s Certification of Compliance with Rule 12(a)(2) (07/2016) Page 1 of 1
Supervisor’s Certification of Compliance with Rule 12(A)(2) of the Rules of Admission
Contact Information
1. Last name:
2. First name:
3. Attorney License Number:
4. Email address:
5. Date of Admission:
6. Mentee:
By signing and submitting this form, I understand that I am certifying each of the following:
I supervised the Mentee’s mentorship that was required by Rule 12(A)(2) of the Rules of Admission.
When the mentorship began, I had been admitted to the Bar of the Vermont Supreme Court for at least 3
years.
The mentorship lasted at least 6 months, during which I met with the Mentee no less than 10 times to
discuss the Mentee’s practice and issues relevant to Vermont practice and procedure.
The Mentee represented to me that, during the mentorship, the Mentee engaged in at least 40 hours of
activities on the mentorship program list compiled by the Board of Continuing Legal Education and certified
by the Board of Bar Examiners as satisfying the requirements of Rule 12(A)(2) of the Rules of Admission. I
have reviewed the Mentee’s Report of Mentorship Activities and it is consistent with the activities that the
Mentee represented to me as having attended.
Date: _______________________________
Signature: ______________________________
