GLOBAL COMPETENCY CERTIFICATE: Level One
Application Form
Quarter/Year:
Check one: Are you a student
Last Name
First Name
Email:
_
Please print clearly
faculty
staff
Middle
Age Range : 17-25__ 26-35__ 36-45 __
46-55__ 56-65 __ 66+__
Department/Division (if faculty or staff):
Student ID :
I am a: SCIE (ESL) student
For students, please provide ID number
College Bridge student
Basic Studies student
College student
What ethnicity or culture* do you most identify with?
*This exercise will be much richer if you are paired with somebody from a completely different
culture.
What do you hope to get out of the Global Competency Certificate Program?
Application Deadline – Dec.16, 2016
Late Deadline* – Jan.6, 2017
*New Winter Quarter students
Please return this application to the Global Engagement Team:
GET Office – Mitchell Activity Center, Room 205H Noon – 4:00pm
(206) 934-3109 
[email protected] or
International Education Programs dept., BE 1113, mailbox of Christina Meares