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Public Interest Internship Program
2015 Summer Grant Application
Please complete the following form and email it to [email protected], along with (1) your most recent resume; (2) a
personal statement, not to exceed four pages double-spaced; and (3) the attached Employer Verification confirming
your internship, no later than March 30, 2015, at 5 p.m.
Applicants will receive an email confirming the receipt of all application documents. If you do not receive a confirmation
email, please call the YLD office at 404-526-8607.
Eligible internship placements must be unpaid and for a minimum of ten (10) weeks and 400 hours.
About You
First Name ________________
MI ________
Address ____________________________ City
Phone ____________________
Last Name __________________________________
______________ State ______ Zip _____________
Email ___________________________________________________
Law School ____________________ [Projected] graduation date
Are you currently enrolled in law school?
Y
N
If no, are you a licensed Georgia attorney?
Y
N
______________________________
About Your Project
Name of sponsoring organization ____________________ Location of internship _________________
Name of supervisor/hiring attorney _______________________________________________________
Have you been offered a summer internship with this organization for 2015?
Y
N
Briefly describe the mission of the sponsoring organization.
Briefly describe the kind of work you will be performing as a summer intern.
Briefly describe what you plan to learn or obtain working for this organization.
Certification
I hereby certify that I have been offered a summer unpaid internship for a minimum of ten (10) weeks and 400 hours with the
sponsoring organization. I also certify that I have not at this time been awarded any other grant money or scholarships to fund my
summer work at this organization in 2015. I understand that while I am encouraged to apply for multiple funding sources, I am not
eligible to receive PIIP funds if I accept grant money from other summer public interest funding sources. If I am selected for PIIP
funds and decide to accept alternate funding sources, I must notify the PIIP committee co-chairs immediately at [email protected]. I
certify that I am either a student in good standing at an accredited law school or a law school graduate or lawyer in the state of
Georgia.
Signed ________________________________________ Date ________________________________
By typing my name above I certify the statements herein to be true and correct, to the best of my knowledge, and that this information can be used
for the purpose of processing my application.
Public Interest Internship Program
2015 Employer Verification
Please have your sponsoring organization complete the following form and return it along with your application.
Name of Organization
Name of Supervisor/Hiring Attorney
_________________________________________
___________________________________
Name of Intern
Timeframe of Internship
________________________________________
___________________________________
Certification
I hereby certify that the intern has been offered a summer unpaid internship.
I hereby certify that the internship is for a minimum of ten (10) weeks and 400 hours with my organization.
I also certify that the intern will be working under the supervision of an attorney for the duration of the internship.
I certify that I am an employee of the sponsoring organization, responsible for hiring or supervising the intern.
Signed ________________________________________ Date ________________________________
By typing my name above I certify the statements herein to be true and correct, to the best of my knowledge.