Elon Law Residencies

Name *

First Name

Last Name

Do you consent to having your supervising attorney with the Guilford County Public Defender speak to professionals outside our office, such as your employer, university officials, or representatives of the State Bar about your intern/extern experience? *

Yes

No

Emergency Contact *

First Name

Last Name

How did you learn about this internship/externship opportunity? *

Referral

Community event

Website

Other

Have you ever worked/volunteered with our office before? *

Yes

No

Do you have any business, family, or personal obligations (not including time availability) that could conflict with your working with our office? *

Yes

No

Are you or, to the best of your knowledge, has any immediate family member been a client of our office during the past five years? *

Yes

No

Have you or, to the best of your knowledge, has any immediate family member been a victim of a crime in the past five years in Guilford County where a police report has been filed? *

Yes

No

Are you applying for an internship/externship to fulfill a requirement of any program? This includes programs for an educational degree. *

Yes

No

Have you ever been convicted of a felony or misdemeanor? You do not have to report arrests or convictions which were annulled, sealed, or expunged. *

Yes

No

Please enter your desired beginning and end dates for your internship/externship. *

Start date

MM

DD

YYYY

*

End date

MM

DD

YYYY