CLINIC PROJECT APPLICATIONHow to Apply:

1. Read our Description of Clinic Services document so you know about our process and how we prioritize and select cases

2. Complete this Clinic Project Application form that provides us with the following information:

a. Project Description answering the following questions:

What is the legal issue you would like addressed? What are the facts or story surrounding the legal issue? Who are the parties involved? (List all organizations and individuals that have a role in

this issue) What would you like the ELC to produce or do for you? How long do you think will this project take? (Provide information about any

important dates.)

b. Contact Information (for you, your organization and any authorized representatives), which we are required by the Law Society of British Columbia to obtain and record

c. Sign the Disclosure of Information that confirms your understanding that while we will treat all information you provide to us as confidential unless you consent to it being treated otherwise, your potential project will be considered by the ELC Society's Board of Directors, who are responsible for formally approving all of our cases.

3. Return a Word version of this form to the ELC by email (csandbor@uvic.ca or elc@uvic.ca). We may contact you for further information.

PLEASE NOTE: We are only able to consider projects for the ELC Clinic that have a completed Clinic Project Application form.

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PART 1: PROJECT DESCRIPTION

1. Matter (brief description or file name)

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2. What is the legal issue you would like addressed?

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3. What are the facts or story surrounding the legal issue?

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4. Who are the parties involved? (List all organizations and individuals that have a role in this issue)

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5. What would you like the ELC to produce or do for you?

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6. How long do you think will this project take? (Provide information about any important dates.)

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PART 2: CONTACT INFORMATION

Name of organization: Click or tap here to enter text.

Name and contact information (phone and email address) of all authorized representative(s):

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Address: Click or tap here to enter text.

City, Postal Code: Click or tap here to enter text.

Phone: Click or tap here to enter text.

Email address: Click or tap here to enter text.

Name and contact information (phone and email address) of all authorized representative(s):

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General nature of the organization’s type of business or activities

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General nature of the organization’s type of business or activities

Incorporation/business identification number (BIN) and place of issue of incorporation or BIN

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PART 3: DISCLOSURE OF INFORMATION ACKNOWLEDGMENT

The client acknowledges that it is providing information that will be considered by the Board of the Environmental Law Centre Society, so that the Board can determine whether the Centre can provide legal services to the client. The Environmental Law Centre Society will treat all such information as confidential unless the client consents to it being treated otherwise. This completed form must be received before the Board can discuss the matter.

If the client is a lawyer or law firm, they confirm they will not be paid at all for the work that the ELC does for them and they are either EDRF funded or acting pro bono or for a reduced fee.

Click or tap here to enter text. ______________________________

Name of authorized representative Signature of authorized representative

Please return a Word version of the ELC Clinic Project Application by email to csandbor@uvic.ca and elc@uvic.ca.

Originals may be mailed to:

Environmental Law CentreMurray and Anne Fraser BuildingUniversity of Victoria, PO Box 1700 STN CSCVictoria, BC V8W 2Y2

For more information about the ELC, please see our website at: http://www.elc.uvic.ca