Enrollment Form

To be eligible to enroll in the Interdisciplinary Environmental Clinic, you must (1) register on-line and (2) obtain permission from the instructors. In order to obtain the instructors' permission, please fill out the form below and click on "Submit." If you are unable to use the online form or receive an error message, please complete the downloadable form (Adobe PDF format) and return it by email to Ken Miller, Clinic Environmental Scientist, at kmiller@wulaw.wustl.edu, or by campus mail to Campus Box 1120 as soon as possible.

Name:
Telephone
E-mail:
Graduation Date:
Degree:
Please list all environmental courses you have taken:
Please list other courses you have taken that you think are relevant:
Statement of interest - Explain why you are interested in taking this clinic.  Please send your resume if you have one.