* = Indicates required field

*First Name:

*Last Name:

*Student ID Number:

Phone Number

*Email Address:

*I plan to graduate in:

*How did you hear about the program?

*Which area of workplace law interests you the most? (e.g. employment law, employment discrimination law, labor law, etc.)

Have you already completed the online Workplace Law Certificate Application?
Yes
No

Are you interested in learning more about the associated student organization "Employment Law Association" (ELA)?
Yes
No

*Are you interested in attending events, activities and/or programs sponsored by the Workplace Law program?
Yes
No

Additional comments/suggestions: