diff --git a/www/conservancy/apps/assignment/forms.py b/www/conservancy/apps/assignment/forms.py
new file mode 100644
index 0000000000000000000000000000000000000000..5016ff917b2501590e1f6073eae4a1c7c8545650
--- /dev/null
+++ b/www/conservancy/apps/assignment/forms.py
@@ -0,0 +1,59 @@
+from django import forms
+from django.core.validators import ValidationError
+from django.utils import timezone
+
+from .models import Assignment
+from .terms import TERMS
+
+
+def validate_in_past(value):
+    if value >= timezone.now().date():
+        raise ValidationError('Enter a date in the past')
+
+
+class AssignmentForm(forms.ModelForm):
+    period_begins = forms.DateField(
+        label='Start of period to assign',
+        required=True,
+        widget=forms.DateInput(attrs={'type': 'date'}),
+        validators=[validate_in_past],
+    )
+    period_end_type = forms.ChoiceField(
+        label='End of period to assign',
+        choices=[
+            ('all future contributions', 'all future contributions'),
+            ('a specific past date', 'a specific past date (specify below)'),
+        ],
+        widget=forms.RadioSelect(),
+    )
+    period_ends = forms.DateField(
+        label='Specific past date (if applicable)',
+        required=False,
+        widget=forms.DateInput(attrs={'type': 'date'}),
+        validators=[validate_in_past],
+    )
+    agreement_terms = forms.CharField(
+        widget=forms.Textarea(attrs={'readonly': 'readonly'}),
+        initial=TERMS,
+        help_text='Please be aware that some employment agreements explicitly transfer copyright ownership to the employer. We recommend you review your recent employment agreements for such clauses.',
+    )
+
+    class Meta:
+        model = Assignment
+        fields = [
+            'full_name',
+            'email',
+            'country_of_residence',
+            'repositories',
+            'all_emails',
+            'period_begins',
+            'period_end_type',
+            'period_ends',
+            'agreement_terms',
+            'attestation_of_copyright',
+        ]
+
+    def clean_period_ends(self):
+        cleaned_data = super().clean()
+        if 'period_begins' in cleaned_data and 'period_ends' in cleaned_data and cleaned_data['period_begins'] > cleaned_data['period_ends']:
+            raise ValidationError('End of period is before start')