Declaration of Supervising Attorney

I, Name of Supervising Attorney	, am a Pennsylvania-licensed attorney in good standing and am engaged in the practice of law in Pennsylvania. I certify that I will supervise Name of Applicant	in the performance of legal work at the employer named below should the applicant be permitted to practice law in Pennsylvania under Order No. 837 of the Pennsylvania Supreme Court, dated April 28, 2020, permitting persons unable to sit for the July 2020 bar examination because of COVID-19 to qualify for a limited license.

I affirm that I meet the requirements of a “Supervising Attorney” as enumerated in Order No. 837.

I agree to notify the Board in the event the applicant leaves my employment or supervision.

I understand that the supervision required must be sufficient to ensure I have knowledge of the specific conduct at a time when its consequences may be avoided or mitigated and that I ratify the conduct.

I understand that the limited license granted under Order No. 837 will expire without notification if any of the provisions of the rule are no longer satisfied.

I will assume responsibility for the applicant’s work should the applicant’s limited license expire.

I understand that the applicant will be subject to all duties and obligations of active members of the Pennsylvania bar, including, but not limited to: the Rules of Professional Conduct and the Rules of Disciplinary Enforcement.

Employer:	Employer

Address:	Employer Address

Position:	Position of Supervisor

I verify that the statements of fact made by me in this declaration are true and correct and that they are made subject to the penalties of 18 Pa. C.S. § 4904 relating to unsworn falsification to authorities. I further verify that I have not omitted any facts or matters pertinent to this declaration.

Supervisor Signature:

Date:	Date Signed

Print Name:	Supervisor Name

Bar Number:	Supervisor Bar Number

Phone:	Supervisor Phone

Email:	Supervisor Email