URL: DomesticSummerPublicInterestProgram2014PA.xml
WULS: Summer 2014 Domestic Summer Public Interest Program

Summer 2014 Domestic Summer Public Interest Program

For students who have a placement

If you have any questions about this form, please contact contact Carol Vizzier cvizzier@wulaw.wustl.edu.


1. Identification

First name: *
Middle Initial: *
Last name: *
Student ID: *
Social Security #: *
Marital Status (please indicate): *
Domestic Partner

Citizenship (check one) *

Citizen or National of the U.S.
Lawful Permanent Resident
Alien # A
(fill in the rest of the number):
An Alien Authorized to Work
Authorized to Work Until:
Alien # or Admission # (fill in the number):

2. Degree Pursued

Are you a joint-degree candidate?: *
If yes, what degree are you seeking in addition to the JD?:
What is your projected graduation date?: *

3. Local (St. Louis) Address

Street: *
City: *
State: *
Zip: *
Phone Number: *
(Please include area code)
My Phone Type: *
I've entered my Home Phone Number
I've entered my Cell Number
Campus e-mail: *
(This must be a Wash U address in this format: username@go.wustl.edu)

Other e-mail address: *
Gender: *
MaleFemale Other
Birth Date: *
Birth Country: *
Birth State: *
Birth City: *

Veteran Status (please indicate) *

Armed Forces Service Medal Veteran
Disabled Veteran
No Military Service
Other Protected Veteran
Vietnam-Era Veteran
Newly Separated Veteran

(Enter the date of separation)

Are you Hispanic or Latino?: *
Select ALL that apply: *
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander

Is this the city in which you hope to practice after graduation? *


If you answered No, in which city/cities are you hoping to practice? *

Explain briefly but specifically why you have chosen this placement. How will this placement further your career goals and your law school experience?

How will this placement help you find a position for your 2L summer? *

The specific educational or practical goals for the summer. (e.g., research and writing, development of or exposure to particular legal skills, practices, or proceedings or expertise in an area of law practice) *

The specific nature of your anticipated work in the office (after consulting with the placement site supervisor) *

How this placement fits into your overall educational program *

4. Summer 2014 Public Interest Program Placement Agency Information

Placement Agency Name: *
Placement Agency Street Address:
Placement Agency City:
Placement Agency State:
Placement Agency Zip:
Supervisor's Name:
Supervisor's E-mail Address:
Supervisor's Phone Number:
Supervisor's Fax Number:

5. Please check EACH APPLICABLE paragraph *

I am a first-year student at Washington University School of Law.
I have read and understand the materials setting forth the terms and conditions of the Summer Public Interest Program.
I have accepted an unpaid legal position with the placement agency designated on this form. I have committed myself to perform at least 300 hours of unpaid work for this placement agency between May 19, 2014 and August 22, 2014. I understand that Washington University School of Law is my employer for purposes of receiving the public interest award funding for this placement and that I will be required to submit bi-weekly timesheets on a regular scheduled basis. My time reports to Washington University will compromise no more than 8 hours worked daily and no more than 40 hours worked in any week. I understand if my service to the placement agency exceeds the program required 300 hours or the daily and weekly work hour limits and that if bill these hours on my time reports to Washington University, I will not be paid for the hours in excess and that these hours will be considered volunteer service to the agency. I will also be required to complete all employment paperwork, including completion of the I-9 form online and present original, unexpired documents verifying my work eligibility to law school personnel before May 19, 2014.

6. I Agree

Please check each applicable paragraph.

I have fully disclosed my intentions to engage in this outside employment to my Summer Public Interest Program placement agency and have provided information to ensure that no conflicts of interest exist for my Summer Public Interest Program placement agency, or that conflicts have been addressed and resolved.
I am receiving no academic credit for the unpaid legal work undertaken in the course of the Summer Public Interest Program placement.
Failure to meet the time reporting and progress reporting requirements of the program by the announced deadlines will result in non-payment and/or partial payment of program funds.
Failure to perform a total of 300 hours of unpaid work for the placement agency will result in non-payment and/or partial payment of program funds.

I agree that at the conclusion of my summer internship I will complete the survey for the Share It Forward It Database.
I will meet with my JD advisor at least once before June 2014 and once during the Summer 2014.

I will commit to attend professional networking events.

I will update my Symplicity profile.

I will do at least one mock interview.

I will have my resume updated, approved by my CSO Counselor and uploaded to Symplicity by the end of June.


By submitting this form, I acknowledge, subject to the Honor Code of Washington University School of Law, that the information contained herein is true and complete, as of this date. I will promptly notify the CSO should the information set forth above change.