Sample Application Form - Graduate Certificate in Participatory Research

PID

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Primary Department/School

Degree Pursuing

Degree Advisor Name

First Last

Degree Advisor Email

Expected/Estimated Date of Graduation

Prospective Certificate Completion Date

Geographic Location(s) of Research

How Do You Identify?

Providing information about how you identify helps us track the diversity of our program. Your inclusion of this information is welcomed and voluntary.

Gender

Race

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other

Prefer Not to Answer

Certificate Requirement Schedule

Please provide the semester/year you anticipate satisfying the program requirements.

1. Required 1-Credit Course: Current Issues in Participatory Research

2. Core 3-Credit Course: Decolonizing Methodologies

3. Elective 3-Credit Course of Your Choosing

4. Practicum

5. Two Workshops

Statement of background and interest

Accepted file types: pdf, doc, docx, Max. file size: 1 MB.

Please upload Word Document or PDF of your statement of background and interest.

Procedures

Once admitted, the student will be added to a GCPR Sakai site. There, the student must maintain a list of qualifying courses with dates of completion and grades, Workshop Completion Forms, and a complete practicum portfolio. These materials should be updated in Sakai as the student completes each requirement.
Upon completion of all requirements, the student must submit a GCPR Completion Form and unofficial transcript via Sakai. At that point the Completion Form and all materials will be reviewed by the Program Director. Once approved, the student will be notified and their information submitted to the University Registrar for inclusion of the GCPR on their transcript.

Signatures

Date of Signature(Required)

Please enter the date on which you digitally signed this form.