REQUEST FOR INFORMATION
& FEEDBACK FORM

This information will be forwarded to the HPL Lab Manager. 
All information contained in this form will be kept strictly confidential and will not be shared.

NOTICE: This form is not intended to request graduate school applications!!  This form is for
the sole use of asking general questions of the HPL, requesting that somebody contact
you personally, or for you to provide us feedback.  Please contact Dorothy Adams in the MIE
Department to request an application for admission.  You can, however, ask us general
questions about our specific graduate program in Human Factors.  :-)

Full Name
Affiliation / School
Are you .......     A student interested in our Human Factors program?
          -- Which level?   Bachelors of Science     Master of Science    Ph.D.
          -- What University / College do you currently attend (if applicable)?
             
    A professional in industry?
         -- Company? 
    A professor at UMass?  
         -- Department?
    A professor from another University or College? 
         -- Univ. / College?
Contact Information    Phone Number :   Ext. 
   email address:   
     Please contact me (we will attempt to email you before we call)
     I will contact you
How did you hear about us?
I ....      want to know more about your Human Factors Program.
     am planning on applying to your Human Factors Program.
     am interested in arranging a lab tour and meeting with you all.
     am interested in possibly collaborating with your lab.
     have a Human Factors problem and I'd like some advice.
     am a wonderful person and ... darn it! ... people like me!  (self-affirmation)
I have a specific question / request
How can we improve our website?