latin american and caribbean studies application …...lacs certificate application 1 latin american...
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LACS Certificate Application 1
Latin American and Caribbean Studies Application to Complete the PhD Certificate Program
___________________________ ___________________________ ____________ Last Name (Last, First) Department UCID ___________________________ __________________________________________ Program Start Date (Quarter, Year) Anticipated Program Completion Date (Quarter, Year) LANGUAGE Select all that apply
___Course Completion
Please list courses completed (course number + title):
1.______________________________________________________________________
2.______________________________________________________________________
3._______________________________________________________________________
___Graduate Reading Examination OR ___Translation Examination
Language: ___________________________ Date exam taken: ___________________________
___FLAS summer award
Award Year(s):________________ Award Language: ___________________________
___Native or bilingual proficiency
Language(s): _____________________________________________________________________
LACS Certificate Application 2
COURSES Please list courses completed (Course number + title):
1.______________________________________________________________________________
2.______________________________________________________________________________
3.______________________________________________________________________________
4.______________________________________________________________________________
WORKSHOP PARTICIPATION Please detail workshop participation, including workshop(s) coordinated, and dates of presenter/discussant participation:
LACS Certificate Application 3
DISSERTATION TITLE A working title is acceptable. DISSERTATION SUBJECT Please give a brief description of your dissertation subject below (max 250 words). ------------------------------------------------------------------------------------------- APPLICATION REVIEW ______Approved ______Declined Date:_________________ Signature:_________________________________________ NOTES:
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