Application for Certification as a Legal Intern

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* Since you applied to this law school, have you been convicted of or are you presently charged with any criminal offense in any civilian or military court (excluding minor traffic and parking offenses) or have you previously served or are you currently serving a term of probation or a pre-trial diversion program?

Yes No

(Driving under the influence of drugs or alcohol is not a minor offense and must be reported. Convictions or diversions which have been expunged must also be reported.)

If your answer is yes, give a statement below explaining the factual circumstances of the offense, the date of the charge, conviction or diversion, the name and location of the court and the disposition or current status of the matter.

If you are charged with any criminal offenses while serving as a legal intern, you have an obligation to notify the Law Clinic Director.

Statement:
(* required if Yes)

* Name:

* Email:

* Date:

By entering my name in the field above and clicking the Submit button below I attest that the answer and information provided in this submission is true to the best of my knowledge.