Latin American and Caribbean Studies Application …...LACS Certificate Application 1 Latin American and Caribbean Studies Application to Complete the PhD Certificate ProgramLACS Certificate

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: