Registration Form Summer 2014

Thank you for your interest in the New York Summer Seminar at the Benjamin N. Cardozo School of Law. Please answer the following questions to get you started on the road to your Summer in New York City.

* 1. Demographic Information

* 2. Passport Information

* 3. Date of Birth

Date of Birth:

* 4. Please indicate your gender:

* 5. Legal Education

* 6. Current Employment

* 7. Emergency Contact: Please provide contact information for two people we can contact in case of emergency.

* 8. Housing Reservation

* 9. Will you require a visa for participation in this program?

* 10. Do you have any allergies, physical or psychiatric condition that might need treatment or attention while you are in New York, or which would inhibit your ability to participate in any aspect of the program? Please explain/comment.

* 11. Is there any other medical condition we should be aware of?

* 12. Dietary Restrictions

* 13. Is there any additional information concerning your health that the program staff should know about in order to provide you with the best support possible during your study abroad experience?

It is highly recommended that you have a complete physical examination prior to leaving for your study abroad experience. You must notify Cardozo of any relevant changes in my health that may occur prior to the start of the program.

* 14. If there is anything else about yourself that you would like us to know, please tell us.

* 15. How did you hear about the NY Summer Seminar?

* 16. If recommended by prior program participant, please provide his/her name:

* 17. I certify that the information on this application is correct and complete. I understand that on becoming a student in this program, I shall be subject to all rules, regulations and requirements as to conduct, academic, housing policies of the Cardozo School of Law or the Housing Program. Use of illegal drugs/substances; excessive drinking of alcohol; abusive, violent, unsafe behavior; theft; vandalism; chronic defiance of program policies and established rules; or other pervasive negativity will not be tolerated. I understand that violation of these guidelines for participation will result in dismissal at the sole discretion of program leaders without rebate and with additional travel expenses charged to and paid for by the student.

Electronic Signature (Type your full name here):