APPLICATION FOR SMALL BUSINESS CLINIC

1.	Name:
2.	Address:           		  
3.	Email address:	
4.	Telephone numbers where you can be reached this semester and over summer break:
5.	I attended/will attend a Clinic/Externship Advising Session with Professor_________________ on  _____________________.
6.  Curricular background 
	a. Are you taking or have you taken any other clinical course?  Yes___  No ____
	    If yes, please identify:
          c. Have you taken your QWC?     Yes	    No__
    	   If so, which QWC? 
    	   If not, when and what QWC do you plan to take?
d. List all the business related courses you have taken so far in law school:
	
e. List the business related courses you plan to take next year:            
7. Other time commitments:
		a. How many total credit hours will you be taking in the:
		    fall semester       _________
               spring  semester  _________
								
If you are accepted to the small business clinic, and this number increases, please contact Professor Statchen immediately.  It is not recommended that students in this clinic take more than 15 credit hours including the clinic credits.
         
		b. What other commitments will you have during the semester in which you would like 	     		     to participate in the clinic?  (Work?  Extracurricular activities?  Law Review?) 
		     Please specify (1) the nature of the commitment, (2) the amount of time per week 		     	     that you expect to devote to outside commitments, and (3) whether you would be      	     		     unable to do clinic work during any specific days during the semester? If your other 			     commitments change (increase) after being accepted into the Clinic, it is your 		   	           responsibility to notify Professor Statchen immediately.
         
           c. Will you be able to devote a minimum of 22 hours to the clinic each week in addition to 
    the 2 hour seminar? Yes___ No___ 
 
	d.  Do you intend to take more than 15 credit hours during the semester you are selected for the 
               clinic?  Yes___ No___ 

8.  When do you expect to graduate? 
9.  Please describe any school, life or job experience which you believe is relevant to the clinic.
     If you have worked in a law office or in a law-related job, please specify the type of work you 
     have done (research, writing, drafting, closing preparations, etc.).
10.	Please explain your reasons for wanting to join the clinic.  What do you hope to get out of it? 
Is there anything else 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.