LOYOLA UNIVERSITY CHICAGO
SCHOOL OF LAW
EXTERNSHIP PROGRAM
FIELD PLACEMENTS
FALL 2016
INTERNAL APPLICATION
DUE DATE: JULY 15, 2016
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EXTERNSHIP APPLICATION, HONOR STATEMENT AND
ACKNOWLEDGEMENT
Students who have secured an externship at an approved site must submit a completed application to Josie M. Gough,
Director of Experiential Learning. The application should be submitted to Ms. Gough by personal delivery to her office,
Room 1331. Upon approval of the application by Ms. Gough and processing by the Law School’s Registrar, you will be
able to register on LOCUS within the next 24-48 hours.
THIS APPLICATION MUST BE PROVIDED TO MS. GOUGH FOR PROCESSING NO LATER THAN JULY 15, 2016.
YOUR APPLICATION WILL NOT BE PROCESSED WITHOUT THE FOLLOWING INFORMATION.
(PLEASE PRINT)
Student
Class
ID #
Year
Phone:
GPA
Name:
Email:
SECTION 1.
1.
Indicate whether you are a full-time or part- time student.
2.
Indicate the number of credit hours you have completed to date.
3.
Specify the number of hours you have earned, if any, as an extern to
date.
Specify the number of non-graded credits that you have earned as of
the date of this application.
Circle the number of credit hours that you expect to earn as an extern
during the FALL semester.
4.
5.
6.
7.
8.
Indicate the total number of credit hours you will register for during the
FALL semester (including externship hours).
Please indicate if you have secured your Illinois Supreme Court Rule 711
License.
Please indicate if you have completed Professional Responsibility.
Full
Part
Credit
Hours:
Credit
Hours:
Credit
Hours:
Credit
Hours: 2
Credit
Hours: 3
Credit
Hours:
Yes
No
Yes
No
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SECTION 2.
State the name of the extern site or name of the member of the judiciary that you will be assigned to as an extern
during this semester. _____________________________________________. Please place a check mark next to the
course you have selected. THIS IS HOW IT WILL APPEAR ON YOUR TRANSCRIPT.
Once your application is approved, it will be submitted to the Law School Registrar for further processing. You will
then be required to register yourself through LOCUS using the number of the course, section, and class number listed
below. Please remember to include the number of credit hours you are applying for when you register.
Professor Kieffer’s will class meet at 3pm on Tuesday’s in room 106. Professor Gough’s class will meet at 4pm on
Tuesday’s in room 1103. SELECT ONE CLASS ONLY.
KIEFFER
ONLY
3:00 PM
Room 106
COURSE TITLE
NUMBER
SECTION
CLASS #
599
002
3330
599
004
3332
599
006
3334
599
599
008
010
3335
3617
599
012
3644
599
014
5391
599
016
5393
599
018
5395
Externship-Intensive Field Placement: Intellectual Property
599
020
5397
Externship-Intensive Field Placement: Judicial
599
022
5400
599
024
5402
599
026
5404
Externship-Intensive Field Placement: Alternative Dispute
Resolution
Externship-Intensive Field Placement: Child and Family Law
Externship-Intensive Filed Placement: Consumer
Protection/Antitrust
Externship-Intensive Field Placement: Corporate Law
Externship-Intensive Field Placement: Criminal Law
Externship-Intensive Field Placement:
Entertainment/Creative Arts/Sports
Externship-Intensive Field Placement: Government
Externship-Intensive Field Placement: Government
Relations/Public Affairs
Externship-Intensive Field Placement: Health Law
Externship-Intensive Field Placement: Professional
Responsibility
Externship-Intensive Field Placement: Public Interest
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GOUGH
ONLY
4:00 PM
1103
COURSE TITLE
NUMBER
SECTION
CLASS #
599
001
3227
599
003
3331
599
005
3333
599
599
007
009
4077
3336
599
011
3618
599
013
4817
599
015
5392
599
017
5394
Externship-Intensive Field Placement: Intellectual Property
599
019
5396
Externship-Intensive Field Placement: Judicial
599
021
5399
599
023
5401
599
025
5403
Externship-Intensive Field Placement: Alternative Dispute
Resolution
Externship-Intensive Field Placement: Child and Family Law
Externship-Intensive Filed Placement: Consumer
Protection/Antitrust
Externship-Intensive Field Placement: Corporate Law
Externship-Intensive Field Placement: Criminal Law
Externship-Intensive Field Placement:
Entertainment/Creative Arts/Sports
Externship-Intensive Field Placement: Government
Externship-Intensive Field Placement: Government
Relations/Public Affairs
Externship-Intensive Field Placement: Health Law
Externship-Intensive Field Placement: Professional
Responsibility
Externship-Intensive Field Placement: Public Interest
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Section 3.
Employment, co-curricular or extracurricular activities or volunteer responsibilities that present actual or potential
conflicts will not be approved. It is critical that you disclose any actual or potential conflicts that would jeopardize
your duty of confidentiality and loyalty owed to your prospective externship placement. Students have a continuing
obligation to update this section with the Course Instructor during the semester you are engaged in an externship
placement. Students who apply for a position with the Circuit Court of Cook County may not also work in any
other legal capacity (paid or unpaid) while serving as an extern. Students may work as research assistants or as
tutors on behalf of the law school faculty. This information must be disclosed to the court and the law school.
In order to make those assessments, please answer the following series of questions.
1. Please indicate whether you will be employed or if you are working as a volunteer during the
semester. If the answer is yes, please also indicate where you are working/volunteering, the
nature of the work and the number of hours you will work/volunteer.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
2. If you are not currently employed or volunteering but you plan to do so during the semester,
please respond to the questions listed in number 1 above.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Yes No.
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_______________________________________________________________________________
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HONOR STATEMENT
I have reviewed the information regarding the extern program on the Loyola University Chicago School of Law
website in its entirety. I agree to complete all program requirements and to honor my commitment to the extern
site or judge listed above in order to receive course credit. I have disclosed any and all matters that may present
a conflict of interest.
I am not receiving any form of compensation from any source for work performed as an extern at the field
placement site that I have applied to during this semester.
Should I not comply with all the requirements for extern course credit, I am aware that credit may be withheld.
Student’s Signature: ______________________________
Date of Submittal:
______________________________
FOR OFFICE USE ONLY
APPROVED ______ NOT APPROVED ______ Date _____________________ BY:________________________
Date Submitted to the Office of the Registrar: ___________________________________________________