Rule 48 Georgetown Student Certification Form Page 2
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2answer. If your debt has been sent to a collection service or if you have executed a
repayment agreement for any delinquent debt, you must answer yes.
____ Yes
____ No
* If you answered yes to this question, you must submit a statement explaining what
happened and include supporting documents or records.
5. During the past five years, have you been a party in any civil proceeding (including
landlord/tenant and bankruptcy matters) or family law matter (including continuing
orders for child support)?
____ Yes
____ No
* If you answered yes to this question, you must submit a statement explaining what
happened and include a copy of the court judgment.
Note: If you have been subject to sanctions for violations of Georgetown’s
Student Discipline code, that information will be relayed to the Associate
Dean for Experiential Education and may affect your ability to participate
in a clinic. If new information arises relevant to these questions at any
time prior to your completion of the clinic, you are required to disclose
that information and supplement your answers and supporting documents
as needed.
If you need additional information about answering these questions, email Rachel Taylor,
Assistant Dean of Experiential Education, at rst@law.georgetown.edu.
In addition to answering the above questions, you must certify that you have read both D.C.
Court of Appeals Rules 48 and 49 in this document:
and the D.C. Rules
of Professional Conduct.
Do you certify that you have read these rules?
______ Yes
______ No
I hereby certify that the information set forth above is true.
NAME
SIGNATURE
DATE
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