Primary Information
*Name:
*Banner ID:
*Email:
Address: Apartment #:
City: State: Zip:
Daytime Phone: ()-
Evening Phone: ()-
 
*The address listed above is for: (check all that apply)
Billing Business Grades Home Local Registration

Secondary Information
Name:
Banner ID:
Email:
Address: Apartment #:
City: State: Zip:
Daytime Phone: ()-
Evening Phone: ()-
 
*The address listed above is for: (check all that apply)
Billing Business Grades Home Local Registration N/A

*Publish address in the Law School Directory? Yes No
 
In case of emergency, call:
Phone: ()-
 
Are you currently employed? Yes No
If so, how many hours per week?
 
*Signature: