®
Diversity Clerkship Program
Employer Commitment Form / Summer 2017
Deadline to commit as an Employer is January 11, 2017. The success of our
program depends on employers honoring their commitment to participate. The
number of students selected to participate is based on the number of confirmed,
committed employers. If an employer withdraws from the program after the January
11, 2017 commitment date, it severely disrupts the interview and selection process.
Name of Employer: ________________________________________________
Please indicate your level of interest in our summer 2017 program.
Commit
Our contact person for this program is:
Name: ___________________________________________________
Title: ____________________________________________________
Direct Telephone Number: ___________________________________
Email: ___________________________________________________
Company/Organization: _____________________________________
Cannot Commit
Please share your reason for not participating:
Mail or email this form to:
Lois Berning ([email protected])
Diversity Clerkship Program
State Bar of Wisconsin
PO Box 7158
Madison, WI 53707-7158