2024 George P. Kazen Fellowship Supplement Application
Name
*
First Name
Middle Name
Last Name
Suffix
Email
*
example@example.com
Cell Number
*
Please enter a valid phone number.
Confirmation of Eligibility
Check all that apply
Copy of Identification
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Copy of Proof of Eligibility to Work
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Accepted files: pdf, doc, docx, jpg, jpeg, png, gif. Max 10MB file.
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Consent and Release for Informational and Educational Use of Still Images, Video, and Audio Recordings
Please read carefully.
Waiver and Release of Personal, Academic and Enrollment Information
Please read carefully.
Program Attire
Blazer Size
*
Please Select
Men's Small
Men's Medium
Men's Large
Men's X-Large
Men's 2X
Women's Small
Women's Medium
Women's Large
Women's X-Large
Women's 2X
T-Shirt Size
*
Please Select
Small
Medium
Large
X-Large
2X
Transportation Acknowledgement
The Kazen Fellowship Program operates out of the George P. Kazen United States Courthouse at 1300 Victoria St., Laredo, Texas 78040, on Mondays through Fridays from 9am to 5pm during the duration of the program.
How will you travel to and from the courthouse?
*
I need assistance with transportation.
I will have personal transportation and do not need assistance.
Release of Liability, Waiver of Claims, Express Assumption of Risks, and Hold Harmless Agreement
Participant Student Name
*
First Name
Last Name
Participant Student Signature
*
Parent/Guardian Name
*
First Name
Last Name
Relationship to Participant Student
Please Select
Mother
Father
Guardian
Parent/Guardian Signature
*
Date/Time
Submit
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