APPEARANCE OF LAW STUDENT INTERN STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov JD-ES-96 Rev. 10-06 Pr. Bk. §§ 3-15, 3-16 TO: The Superior Court of the State of Connecticut JUDICIAL DISTRICT OR G.A. NO. ADDRESS OF COURT (No., street, town and zip code) NAME OF APPLICANT (Law Intern) DOCKET NO. NAME OF CASE NAME AND ADDRESS OF LAW SCHOOL CLASS OF NAME AND ADDRESS OF SUPERVISING ATTORNEY APPLICATION FOR APPEARANCE OF LAW INTERN I hereby certify as follows: 1. I am a law student at the above mentioned Law School and have completed legal studies amounting to at least two semesters of credit or the equivalent. 2. A certificate of the Dean of the Law School that I am of good character and competent legal ability as required by Practice Book § 3-16 has been filed with the Clerk of the Superior Court for the Hartford Judicial District at Hartford. WHEREFORE, I do respectfully request the approval of the Court to appear in this matter on behalf of the party mentioned herein, under supervision of the above named attorney, subject to the provision of Practice Book § 3-14 et seq. SIGNED (Law Intern) DATE SIGNED CONSENT OF PARTY I hereby consent to the appearance on my behalf of the applicant as a law intern to provide legal service and appear in court or administrative tribunals for me in the above-captioned matter under the supervision of the above named attorney. SIGNED (Consenting party) DATE SIGNED CONSENT OF SUPERVISING ATTORNEY I hereby certify that: ("X" one) I have been admitted to the Connecticut Bar for at least three years; I am employed by an attorney of five years standing; I am employed by an accredited law school in Connecticut. I hereby assume personal professional responsibility for the work of the applicant as a law intern under Practice Book § 3-15, agree to supervise said intern in accordance with the requirements of said § 3-15, and approve his/her appearance in this matter. SIGNED (Supervising attorney) DATE SIGNED FOR COURT USE ONLY The above application/appearance is hereby: SIGNED (Judge of the Superior Court) APPROVED. DENIED. DATE SIGNED American LegalNet, Inc. www.FormsWorkFlow.com