Student Name Student Phone Student Address Student City, State, Zip Student E-mail address Anticipated Graduation Date Supervising Attorney / Contact Person Title Attorney Mailing Address Attorney City, State, Zip Attorney Phone Attorney FAX Attorney E-mail address Estimated Total Hours of Work Proposed Semester of Placement Supervisor's name (if different from above) Supervisor's Phone Supervisor's E-mail Organization you are volunteering with Government Mediation Legal Services Corporation Non-Profit Briefly describe sponsoring organization Briefly describe the placement Subject Area Bankruptcy Children's Rights/Juvenile Law Citizen's Rights/Human Rights Constitutional Law Consumer Protection Contracts Criminal Law Descendants Estate/Probate Disability Economic Community Development Education Employment Law Entertainment Law Environmental Law Family Law General Pro bono Practice Health Housing Immigration Indian Law International Law Labor Law Legislative analysis Minorites Non-Profit Poverty Law/Public Benefits Prisoner Care Prosecution Tax Women's Rights Type of Work Administrative Hearing Arbitration Case Management Discovery Interviewing Investigating Legislative Reform Mediation/Dispute Resolution Negotiation Research Teaching Training Trial Preparation Writing Other Type of Client American Indian Children Criminal Defendants Custody Cases Elderly Employees Government/City Government/County Government/State Government/Federal Homeless Individuals Homeowners Indigent Clients Individuals with Disabilities Individuals w/Terminal Illness Institutional Residents Legislators Non-Profit Organizations Prisoners Victims of Domestic Violence Women Will the student be employed by the Sponsoring Organization or Individual Firm during the period of the proposed placement? Yes No Are there any law school courses or training prerequisites required for the proposed placement? What, if any training will be provided by the Sponsoring Organization or Individual Firm for the proposed placement? COMMENTS:
