Latin American and Caribbean Studies Application ... LACS Certificate Application 1 Latin American and

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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:

    Last Name Last First: Department: UCID: Program Start Date Quarter Year: Anticipated Program Completion Date Quarter Year: 1: 2: 3: Language: Date exam taken: Award Years: Award Language: Languages: 1_2: 2_2: 3_2: 4: Date: Check Box25: Off Check Box26: Off Check Box27: Off Check Box28: Off Check Box29: Off Text30: Text31: Text32: Check Box33: Off Check Box34: Off Text35: