CRIMINAL PROSECUTION CLINIC APPLICATION

1.	Name (Please Print)

2.  Address:
     a. Current Semester: 

     b. Summer:

     c. Fall Semester:

     d. Permanent:

3. Date of Birth__________________        

4. Social Security #________________________

5. E-mail Address_______________________________________

6. Driver’s License #___________________________  State of Issue________________________

7.   Have you taken any other clinical course (please specify)?

8.  Will you have completed Criminal Procedure Investigation before the beginning of the fall semester (please specify when completed)?
   
9.   How many total credit hours will you take in the fall semester? ______   Will they include a QWC? ________

10.  What other time commitments will you have during the Fall Semester?  Please note that students may not have outside legal employment while they are participating in the Criminal Clinic.

11.	Every student working in the D.A.'s Office must undergo a criminal record check.  Have you ever been arrested in any jurisdiction for any offense?  Have you ever been convicted, whether by plea or trial, in any jurisdiction for any offense?  If the answer is yes to either question, please provide pertinent details.  Details should be provided in writing either on this form or if you prefer, you may bring the written explanation to your interview. 

12.	I attended/will attend a Clinic/Externship Advising Session with Professor_________________
on  _____________________.

13.	State briefly your reasons for wanting to take this course and other information that you think is relevant to      your application.

The Western New England University School of Law prohibits discrimination in the selection of students for clinical programs on the basis of race, national origin, color, creed, religion, sex, age, disability, veteran status, sexual orientation, gender identity, or associational preference.