Latin American and
LCS Certificate
Program Application Form
Current Semester: __________________ Date: _________________
Student Name: ______________________________________ ID #:
_________________
Permanent Address: __________________________________________________________
__________________________________________________________
Permanent Phone: __________________ Email:
____________________________
Major(s)/Minor(s): ________________________________________________
Major Advisor: ________________________________________________
Expected
Graduation Date: __________________
REQUIREMENTS FOR
THE CERTIFICATE SEMESTER PASSED
ENROLLED (Y/N)
Course: LCS 300 Intro
to Latin America and the
Course: ______ _ _________________________________ ___________ _____
Course: ______ _ _________________________________ ___________ _____
Course: ______ _ _________________________________ ___________ _____
Language Proficiency Requirement completed: ______ (Y/N)
How: ______________________________
** Students Please
Note: You are required to meet with the Program Director each semester to
update your records and discuss your progress toward the completion of the
Certificate Program.
I certify that this student has fulfilled all the
requirements for the LCS Certificate.
__________________________________________ __________________
LCS Director’s Signature Date
Please complete the top portion of
this form and return it to the LCS Program Director, Dr. Julee Tate
(