UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK ____________________________________ V. ____________________________________ No. ___________________ LAW STUDENT INTERN APPEARANCE FORM 1. Law Student Certification I certify that: (a) I am duly enrolled in ___________________________________________ law school in accordance with part (c)(1) of the Student Practice Rule of the Southern District of New York. (b) I am receiving no compensation from the client in accordance with part (c)(6) of the Student Practice Rule of the Southern District of New York. (c) I am familiar and will comply with the Code of Professional Responsibility of the American Bar Association. (d) I am familiar with the federal procedural and evidentiary rules relevant to the action in which I am appearing. __________________________ (date) ______________________________ (Signature of Student) ______________________________ (Print Name) 2. Certification of Law School Dean or Authorized Designee I certify that this student: (a) has completed at least two semesters of law school work and is a participant in an approved clinical program; (b) is qualified, to the best of my knowledge, to provide the legal representation permitted by this rule, and (c) that ________________________________________, who will serve as supervising attorney, is a participant in a clinical program approved by this school. __________________________ (date) ____________________________________ (Signature of Dean or Authorized Designee) __________________________ (Print Name) ___________________________________ (Position of Above) American LegalNet, Inc. www.FormsWorkFlow.com 3. Consent of Supervising Attorney As a member of the bar of the United States District Court for the Southern District of New York, I will: (a) assume personal professional responsibility for this student's work; (b) assist this student to the extent necessary; (c) authorize this student to appear in court or at other proceedings, and to prepare documents, and (d) appear with this student in all proceedings before the Court. __________________________ (date) ______________________________ (Signature of Attorney) ______________________________ (Print Name) 4. Consent of Client or United States Attorney I authorize this student: (a) to appear in court or at other proceedings on my behalf, and (b) to prepare documents on my behalf. I am aware that he/she is not admitted to the bar and that he/she will appear pursuant to the United States District Court, Southern District of New York, Student Practice Rule. __________________________ (date) ______________________________ (Signature of Attorney) ______________________________ (Print Name) (If more than one client is involved, approvals from each shall be attached. If a class action is involved, approvals from named plaintiffs shall be attached.) 5. Consent of Judge I authorize this student: (a) to appear in court or other proceedings on behalf of the above client, and (b) to prepare documents on behalf of the above client. __________________________ (date) ______________________________ (Signature of Judge) ______________________________ (Print Name) American LegalNet, Inc. www.FormsWorkFlow.com