Certificate Program Application

Directions:

You may use the button at the very bottom of the page (you may need to scroll down) to submit your $50 non-refundable Application Fee either before or after you submit your application.

For the application, enter information into each field and press "Tab" or click in the next box to move on. Pressing "RETURN" will submit the form.

If you have any questions, please write us an email via our contact page.

* = required field

* Certificate Title

* Enrollment Year

Personal Information:

* Name

Institution Affiliation

Address

Address2

City

State / Province

Zip or Postal Code

Country

* E-mail

Home Phone

Work Phone

Fax Number

Age

Sex

female
male

Questions:

* Current Degrees, School, and date of receipt: (e.g. BA University of Washington, 2000., etc)

* Current Licenses or Certificates (e.g. CNT, Nutritional Therapy Association, Olympia, 2005)

* What is your academic, professional, or other background? (Please use 1 - 2 pages.)

* What are your goals for internship, certificate or MA degree? (Please use 1 - 2 pages.)

* Are you applying for the Masters Degree option?

* Proposed Entrance Date?

Click the "Pay Now" button below to send your $50 non-refundable application fee. You may use a credit card or PayPal™ (a PayPal™ account is NOT required.)

Center for World Indigenous Studies