Hacker Lab - SETA Client Class Signup Request
This form is intended to be filled out by SETA one-stop providers and qualifying SETA partners to sign up clients for classes at Hacker Lab.

Please fill out all information in the below form. Once submitted, Hacker Lab will verify the information, reach out if we have any questions, and send a confirmation email once completed. Additionally, we will send a confirmation email to the client as well with Zoom login credentials. Please allow 1-2 business days for this process to complete.

All SETA client sessions are billed at $75 per student per class.

If you have any questions, please email seta@hackerlab.org .
Provider Organization Name *
Provider Counselor Name *
Provider Counselor Email Address *
Student/Client Name *
Student/Client Email Address *
Class Requesting Signup For: *
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