Enrollment Form

To be eligible to enroll in the Interdisciplinary Environmental Clinic, you must (1) register on-line and (2) obtain permission of the instructor.  In order to obtain permission of the instructor, please fill out this form and return it to Maxine Lipeles, Clinic Director at milipele@wulaw.wustl.edu or Beth Martin, Clinic Engineering and Science Director at martin@wulaw.wustl.edu or by campus mail (Campus Box 1120, Anheuser-Busch Hall - room 102) as soon as possible.

If you prefer to fill it out by paper, download form (Adobe PDF format) and send it to us.

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.