UCDC Law Program Travel Insurance Requirement Notification, Communications Plan and Placement Information Confirmation Form

UCDC Law Program University of California Washington Center 1608 Rhode Island Ave., N.W., Rm 342 Washington, D.C 20036 (202) 974-6392 (direct dial) (202) 974-6250 (fax) law@ucdc.edu UC Berkeley School of Law UCLA School of Law UC Davis School of Law UC Irvine School of Law UC Hastings School of the Law UCDC Law Program Travel Insurance Requirement Notification, Communications Plan and Placement Information Confirmation Form All students traveling outside the state of California for University-related purposes must sign up for free travel insurance coverage at https://www.ucop.edu/risk-services-travel/index.html Students are required to submit a copy of the insurance card to the UCDC Law Program and to their participating law school by e-mail or regular mail to the Law Program at the address above, and to one of the following: Sue Shechter Field Placement Director UC Berkeley School of Law 421 Boalt Hall #7200 Berkeley, CA 94720 sschechter@law.berkeley.edu Rena Contreras Clinical Office Administrator UC Davis Law School 400 Mrak Hall Drive Room 110 Davis, CA 95616 rgcontreras@ucdavis.edu Lisa Mead Externship Director UCLA Law School Box 951476 Los Angeles, CA 90095 MEAD@law.ucla.edu D’lorah Hughes Nira Geevargis Director of Externships Associate Clinical Professor UC Irvine School of Law UC Hastings College of the Law 401 East Peltason Drive 200 McAllister St Irvine, CA 92697 San Francisco, CA 94102 dhughes@law.uci.edu geevargis@uchastings.edu Name: _ Placement: _ Start Date: End Date: Placement Information Supervising Attorney: Precise office name: _ Address: Phone and e-mail: Communications Plan Page of Student address in D.C area: E-mail: _ Placement phone: Home phone: _ Mobile phone: Emergency Contact Information 1) Name: _ Telephone: _ E-mail: Relationship: _ 2) Name: _ Telephone: _ E-mail: Relationship: _ Dates of Travel Dates of travel from California to your placement: Dates of travel from your placement to California: Dates during placement when you will not at your placement location: ... _ Dates of Travel Dates of travel from California to your placement: Dates of travel from your placement to California: Dates during placement when... E-mail: _ Placement phone: Home phone: _ Mobile phone: Emergency Contact Information 1) Name: ... your placement to California: Dates during placement when you will not at your placement location: