Public Works Leadership Academy Registration Form Please fill out the following form to register for the Public Works Leadership Academy Certificate. Personal Information First Name Middle Name Last Name Have you taken a class at Hamline before? Yes No If yes, please enter your Hamline ID if known. Home Address 1 Home Address 2 City State Zip/Postal Code Date of Birth (Month/Day/Year) Gender Male Female Phone Email Current Employer Current Job Title Are you interested in more information about a Master of Public Administration degree from Hamline? Yes, I am interested. No, I am not interested. How did you hear about this program? (Select) Catalog Email Website Friend Supervisor Community Board Other If other is selected, please specify. Verification Please type your full name: Please type today's Date (day/month/year): By checking the box, you are signing this registration form and agree that doing so is the equivalent of your manual signature. For information about certificate programs, please contact Cynthia Johnson, Non-Degree Programs Coordinator Phone (651) 523-2962, Email email@example.com For billing questions, please contact Hamline Student Accounts, 651-523-3000.