Rule 48 Georgetown Student Certification Form printable pdf download

Rule 48 Georgetown Student Certification Form

Name: _______________________________________________________

Date: _______________________________________________________

Clinic: _______________________________________________________

In the event your response is YES to any of the following questions, you MUST submit a

statement, including the requested supporting documents or records, setting forth the details:

1. Since you were admitted to Georgetown Law, have you ever been cited, arrested, charged

or convicted for any violation of any law (except minor traffic violation)? Alcohol or

drug related offenses and moving traffic violations are not considered to be minor.

____ Yes

____ No

*If you answered yes to this question, you must submit a statement explaining the situation

and include supporting documents or records.

2. Do you currently have any condition or impairment (including, but not limited to,

substance abuse, alcohol abuse, or a mental, emotional, or nervous disorder or condition)

that in any way affects your ability to practice law in a competent, ethical, and

professional manner? As used in Question 2, "currently" means recently enough that the

condition or impairment could reasonably affect your ability to function as a student

lawyer. If the limitations caused by your condition or impairment are ameliorated

because you receive ongoing treatment or because you participate in a monitoring or

support program, you may answer no to this question.

____ Yes

____ No

*If you answered yes to Question 2, you must submit a statement explaining your condition

or impairment.

3. Within the past five years, have you asserted any condition or impairment as a defense, in

mitigation, or as an explanation for your conduct in the course of any inquiry, any

investigation, or any administrative or judicial proceeding by an educational institution,

government agency, professional organization, or licensing authority; or in connection

with an employment disciplinary or termination procedure?

____ Yes

____ No

* If you answered yes to this question, you must submit a statement explaining the situation

and include supporting documents or records.

4. Have you ever been delinquent in any financial obligations, including student loans and

credit cards? Merely making a late payment on a credit card does not require a “yes”

Rule 48 Georgetown Student Certification Form