diff --git a/www/conservancy/apps/assignment/models.py b/www/conservancy/apps/assignment/models.py
new file mode 100644
index 0000000000000000000000000000000000000000..0b8243a62837f2386ddf5c3daf7384fae4adce1d
--- /dev/null
+++ b/www/conservancy/apps/assignment/models.py
@@ -0,0 +1,28 @@
+from __future__ import unicode_literals
+
+from django.db import models
+
+
+class Assignment(models.Model):
+    full_name = models.CharField(max_length=255)
+    email = models.EmailField()
+    place_of_residence = models.TextField(
+        'Country of citizenship or residential address',
+        blank=True)
+
+    repository = models.URLField(
+        'Code repository',
+        blank=True,
+    )
+    coverage = models.CharField(
+        verbose_name='Time period to assign',
+        max_length=50,
+        choices=[
+            ('up to this year', 'One-off up to and including this year'),
+            ('ongoing', 'All existing and new contributions'),
+        ],
+        default='up to this year',
+    )
+    attestation_of_copyright = models.BooleanField(
+        'I attest that I own the copyright on these works'
+    )