Pre-Law Summer Institute Application

American Indian Law Center, Inc.
Pre-Law Summer Institute Application

Personal Data

Application for Summer of

Please type or print neatly in black ink. All information is voluntary. However, failure to complete all applicable portions of this application may result in processing delays or make this application impossible to process.

Name

Mailing Address

City

State/Province

Zip/Postal Code

Permanent Address

City

State/Province

Zip/Postal Code

Current Phone

Perm. Phone Number

Date of Birth

Sex

Male

Female

Marital Status:

Single

Married

Veteran:

Yes

# Dependant Children

Full Name of Spouse

State of Residency?

How Long?

Tribal Affiliation

Degree

Enrollment Number

Home Agency and Address

Other Tribal Affiliation

Degree

Have you ever been convicted of a crime other than a minor traffic violation or had disciplinary action taken against you by a governmental or administrative agency?
(If "Yes," please explain on a separate piece of paper.)

Yes

Have you ever applied to the Pre-Law Summer Institute before?

Yes

If "Yes'" what year?

Have you ever attended the Pre-Law Summer Institute before?

Yes

If "Yes'" what year?

Have you ever attended law school before?
(If "Yes," please list law school, dates and reason for leaving on a separate piece of paper.)

Yes

Law School Application Information

If you have taken the Law School Admission Test (LSAT) more than once, please provide the information on each exam taken, beginning with the most recent.

Date LSAT taken

LSAT Score

Percentile Ranking

Date LSAT taken

LSAT Score

Percentile Ranking

Date LSAT taken

LSAT Score

Percentile Ranking

List law schools to which you have applied for admission.
Law School	Date	Status (Pending, Admitted, Conditional Admit, Denied)

Educational History

Undergraduate Colleges/Universities attended (beginning with most recent).
Name and City	Dates	Degree Received

Undergraduate Major(s)

Cumulative Undergrad GPA

Graduate Schools attended (beginning with most recent).
Name and City	Dates	Degree Received

Field(s) of Emphasis

Cumulative Graduate GPA

Awards & Achievements

Please list any special awards, achievements, offices held, or memberships which you would like considered.

Employment History

Please attach a copy of your resume, or list your three most recent positions, beginning with the most recent on a separate sheet of paper.

Statement of Purpose and Release of Information

I hereby certify that the information supplied by me to the Pre-Law Summer Institute (PLSI) is true and correct to the best of my knowledge. I agree to use any funds I receive from the PLSI solely for my expenses while attending the PLSI, and further agree to repay, on a pro rata basis from the date of termination, any funds I have received if I withdraw or am expelled for cause from the PLSI.

I consent to the release of information in my file or other information regarding my performance in the PLSI to the BIA, other government agencies, law schools, or other appropriate groups, for purposes including, but not limited to: complying with PLSI reporting requirements or other statistical purposes; determining my eligibility; obtaining financial assistance; completing my file; assisting in my admission to law school; or securing temporary or permanent employment.

I further consent to the release by any law school or undergraduate school of any information they have on file regarding me when it is requested by the PLSI for legal purposes including, but not limited to, completing my PLSI file or studying program effectiveness.

Name (printed):_________________________________ SSN:________________________

Signature of Applicant:_________________________________ Date: ________________