Faculté de droit / Faculty of Law
Section de common law / Common Law Section
STUDENT-PROPOSED INTERNSHIP
*Information must be typed*
■ Mrs. Ms. Miss ____________________________ First name: ________________________
Name: Mr.
Student No.: ___________________ Telephone: ____________________ Email: [email protected]
■ Mrs. Ms. Miss  _________________________________________________
Supervisor’s coordinates: Mr.
Address: ______________________________________________________________________________________
City: ____________________ Province/State: ______________________ Country: _________________________
Email:___________________________________ Telephone/Fax: _______________________________________
Exact dates of internship (DD/MM/YR): Start date _____________________ End date _______________________
Please register me in the following course:
CML 3171F (3 credits)
CML 3171J (3 credits)
CML 3171W (3 credits)
 Fall
 January
 Winter
Student Signature:_____________________________________
Date: ____________________
Please check the following page for application deadlines
JD  National Program  PDC  Combined Program 
st
nd
rd
th
1 year  2 year  3 year  4 year 
Name of program and year:
Do you wish to give a title to your internship that will appear on your transcript?
yes  no 
Title: ________________________________________________________________________________________________________________
1 internship  2
st
This Student-Proposed Internship is your:
nd
internship 
Is your proposal attached (N.B.: must be signed by you and your Supervisor - email approval is accepted)?
yes  no 
If no, explain: __________________________________________________________________________________________________________
Is your Student Declaration of Understanding form attached (completed, signed and dated)?
yes  no 
If no, explain: __________________________________________________________________________________________________________
Is your Modification of Registration form attached (completed, signed and dated)?
yes  no 
If no, explain: __________________________________________________________________________________________________________
Note : * All internships are evaluated on a Satisfactory / Non-Satisfactory basis.
* You must submit a final report, the Internship Evaluation Form and the student survey to the CPDC (FTX 233) or
by email at: [email protected]
Professional Development
Counsellor’s approval: _________________________________
57, rue Louis-Pasteur
Ottawa (Ontario) K1N 6N5 Canada
Date: _______________________
57 Louis Pasteur
Ottawa ON K1N 6N5 Canada
(613) 562-5794 ! Téléc. Fax (613) 562-5875