Application for the Summer Program at McGill University

Home Address Information
Home street address:
City/town:
State: Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevana New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming	Zip Code:
Daytime telephone:
Evening telephone:
E-mail address:

Current Mailing Address Information
Current street address:
Current city/town:
State: Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevana New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming	Zip Code:
Daytime telephone:
Evening telephone:

Emergency Contact Information
Emergency contact name:
Emergency contact mailing address:
Emergency contact city/town:
Emergency contact state: Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevana New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming	Emergency contact zip code:
Emergency Contact Daytime telephone:
Emergency Contact Evening telephone:

Law School Information
What law school do you attend?
How many semesters have you completed?

Have you ever been dismissed, suspended, expelled, placed on probation, advised to withdraw for academic reasons, or been subjected to any action for misconduct or an honor code violation at any school (whether or not you have been reinstated):

Have you ever been arrested or charged with a crime other than minor traffic violations?	Yes No
Are there any criminal charges pending or expected to be brought against you?	Yes No
If yes to either of the above questions, please provide complete details, including dates.

I certify that this application is complete and accurate. I will inform Penn State Dickinson School of Law of any occurrences subsequent to the date of this application that would change the answers to any of the questions asked on this application. I understand that any omission, misstatement, or inaccuracy in this application or any supporting materials submitted by me, whenever discovered, may result in the voiding of my registration, in which event I will receive no credit for any attendance at the school.

In addition, your law school must forward: (a) transcript of your law school work, and (b) a letter indicating that you are in good standing and that you have permission to attend the Penn State Dickinson McGill Program as a visiting student. This letter should indicate whether there are any conditions attached by your law school to your participation in this program (i.e. maximum or minimum credits, etc.). All communications should be sent to Mary Mourra, The Dickinson School of Law, The Pennsylvania State University, 1170 Harrisburg Pike, Carlisle, PA 17013-1617.

Applicants may apply electronically or by hard copy. In any event, the application fee of $350 must be separately forwarded to us. Please note that your application will not be processed until your registration fee has been received. The application/registration fee is not refundable. Any returned check is subject to a $25 return check fee per University policy. Make check payable to "The Pennsylvania State University" and return with application materials to:

Mary Mourra, Esq. Summer Program at McGill University The Pennsylvania State University The Dickinson School of Law 1170 Harrisburg Pike Carlisle, PA 17013-1617 Additional information may be obtained by: Telephone: (717) 240-5136 E-mail: mhm11@psu.edu

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