Send application form to:
Legal Secretary Certificate Program
Florida Atlantic University
777 Glades Rd
Continuing Education Hall, Room 201
Boca Raton, FL 33431

Personal Data

Last Name:

First Name:

Middle:

Social Security #:

Date of Birth:

Street Address:

Apt/Suite #:

City:

State:

Zip Code:

Home Telephone:

Work Telephone:

Cellular Phone:

E-Mail:

Certificate Program:

Applicant’s Signature:

Date: