APPLICATION FORM FOR THE INTERNATIONAL RELATIONS CERTIFICATE
Date: __________                                                                                          Wesleyan ID: ___________

Name ________________________________                                        Major(s): ______________

Class:  ______________        Faculty Advisor: ______________         Wes Box: ______________

Permanent Home Address ______________________________________________________
                                                Street                         City                         State                     Zip
Country (if not U.S.) _______________________________________________________

Local Phone: _____________________ Home Phone: _____________________

INTRODUCTORY COURSES:        Econ_________        Hist__________        Gov't__________

COURSES (taken or planned):
COURSE NUMBER SEMESTER 
TAKEN 		 INSTRUCTOR  GRADE
QUALIFYING LANGUAGE COURSE
1. ________ ________ ______________ ________
2.  Alternate Arrangement:______________________________ 
CATEGORY 1 
1.  ________ ________ ______________ ________
2.  ________ ________ ______________ ________
3.  ________ ________ ______________ ________
4. ________ ________ ______________ ________
CATEGORY 2
1. ________ ________ ______________ ________
2 ________ ________ ______________ ________
3 ________ ________ ______________ ________
4 ________ ________ ______________ ________
STATISTICS & OTHER RELEVANT COURSES (Optional)
1. ________ ________ ______________ ________
2. ________ ________ ______________ ________
3. ________ ________ ______________ ________
ADDITIONAL COMMENTS:



PROGRAM APPROVAL:

FACULTY ADVISOR: ________________________________        DATE:  ______________

DIRECTOR, PAC:        ________________________________        DATE:  ______________

RETURN TO CERTIFICATE IN INTERNATIONAL RELATIONS INFORMATION

 

Last updated 09/08