Single-course enrollment application · UW Certificate Program:
Biomedical Regulatory Affairs 2009-2010 (Program ID# 2960)

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To apply for single-course enrollment, please print, complete and mail this form with your required materials to the address below.

I have a professional interest in this field of study and would like to enroll in a single course (course must be designated by Class is also available to professionals who do not intend to pursue the certificate, but wish to enroll in individual classes on a space available basis). My résumé and statement of program experience are enclosed for review. I understand that, if approved, my admission will be on a space-available basis. (No certificate program fee is necessary; tuition is not accepted until you are notified of eligibility.) See details.

Acceptance to the second or third course of this program requires knowledge of terminology and acronyms used in the field of Biomedical Regulatory Affairs.

     Course title:

Note: It is the applicant's responsibility to make sure that all required materials are submitted with the application. All applicants will be evaluated on the basis of materials submitted.


 Mr.    Ms.
 Last name:  
 First name/middle initial:  
 Social Security # (required):  
 Date of birth:  
 Mailing address:  
   
 City/State/Zip:  
 Daytime phone:  
 E-mail address:  

Mail applications to enroll in a single course to:

Certificate Program Applications/Registrations
UW Extension Registration Services
PO Box 45010
Seattle, WA 98145-0010