STUDENT-AGENCY AGREEMENT FORM - BLANK.DOC

Spring 2014
SANDRA DAY O’CONNOR COLLEGE OF LAW
AT ARIZONA STATE UNIVERSITY
EXTERNSHIP PROGRAM
STUDENT/JUDGE OR AGENCY AGREEMENT
This agreement constitutes a mutual understanding between
(Student)
and
(Judge /Agency and Division)
as part of an Externship program with Arizona State University College of Law established for the purpose of
providing educational related work experience to students. It is understood by both parties to this agreement
that:
1) is officially enrolled at ASU College of Law and has received
(Student)
permission to volunteer his/her services as an extern; and
2) the student is not covered by A.S.U. or State of Arizona liability insurance; and
3) the student is providing volunteer services and cannot be compensated for work; and
4) upon satisfactory completion of hours of work will receive credit hours for the
externship experience a maximum of 12 hours of externship may be applied toward graduation
requirements); and
5) the period of volunteer service commences on or about and will end on or
about .
It is further understood that the student will maintain, separately, an attendance record noting the dates and
hours of the student’s attendance on the job, including a brief description of the work completed. Placement
organizations may not bill clients for the time of student externs. In addition, the agency will provide the

Sandra Day O’Connor College of Law at Arizona State University a supervisory appraisal of the student’s
performance both at the midterm and upon completion of the volunteer service period.
Agency Supervisor Name (Please print or type) Student Signature Date
Phone: Fax:
Agency Phone Number
Email Address
Agency Supervisor Signature Date Externship Coordinator Date
Sandra Day O’Connor College of Law
Revised 04/23/2012