INSTRUCTIONS: This is a fillable form: to begin, click on a section and then tab to all other sections. Should you experience difficulty, you may print out this form and fill it in by hand. Fill out the form, print, keeping a copy for yourself, and mail to BOARD OF BAR EXAMINERS, 2418 Airport Road, Suite 2, Barre, VT 05641. You are advised to read the Rules of Admission to the Vermont Bar available on our website at www.vermontjudiciary.org Questions should be directed to jud-attylicensing@state.vt.us TERMINATION OF LAW OFFICE CLERKSHIP FORM Registrant Name: devoted the following amount of time to this clerkship: A: not less than 25 hours during a 7 consecutive day period; OR B: not less than 30 hours in a 14 consecutive day period. State below the number of weeks in which you, the clerk, devoted to your registered law office clerkship: First Month Fifth Month Second Month Sixth Month Third Month Seventh Month Fourth Month Eighth Month Twelve weeks of study are required under Option A and 24 weeks of study are required under Option B to fulfill the clerkship requirement. This completed form should be filed as soon as possible after completion of the clerkship. Signature of Registrant CERTIFICATE OF JUDGE OR ATTORNEY: REGISTRANT'S TERMINATION OF LAW OFFICE CLERKSHIP Judge or Attorney Name: of (Town/City) Vermont, pursuant to the provisions of the Rules of Admission, hereby certifies that on (Date) (Registrant) Signature of Judge or Attorney terminated the study of law in my office and under my supervision. Date American LegalNet, Inc. www.FormsWorkflow.com