APPLICATION FORM: UCD POST-BACCALAUREATE PROGRAM IN CLASSICS
Application by May 1 for Fall Quarter; December 1 for Winter Quarter; March 1 for Spring Quarter. Applications will be accepted after those dates until the program fills.

DATE___________________________

FIRST NAME/MIDDLE INITIAL/ LAST NAME_____________________________________

MALE/FEMALE

CURRENT ADDRESS _________________________________________________________

__________________________________________________________________________

CURRENT PHONE NUMBER AND FAX NUMBER___________________________________

EMAIL ADDRESS ___________________________________________________________

PERMANENT ADDRESS ______________________________________________________

__________________________________________________________________________

PERMANENT PHONE NUMBER ________________________________________________

SOCIAL SECURITY NUMBER* _________________________________________________

BIRTHDATE (MO/DAY/YR)* __________________________________________________

*By Regental authority, your Social Security number is requested in order to verify your identity for accurate record keeping. Your providing the number and your birthdate is voluntary.

U.S. CITIZEN? PERMANENT U.S. RESIDENT? OTHER (SPECIFY CITIZENSHIP) _________________________________________________________________________

SCHOOL OF B.A./ MAJOR OF B.A./ DATE OF B.A. _________________________________________________________________________

OTHER POST-B.A. STUDY? ___________________________________________________

WHERE? _______________________________ WHAT? ___________________________

WHEN? ________________________________

NAME, ADDRESS, PHONE NUMBER OF FIRST COLLEGE REFERENCE

_________________________________________________________________________

_________________________________________________________________________

NAME, ADDRESS, PHONE NUMBER OF SECOND COLLEGE REFERENCE ________________________________________________________________

________________________________________________________________

Please list all Classics courses that you have taken. Use additional sheets as necessary.

Courses in Greek:

_________________________________________________________________________ COURSE TITLE/WHERE TAKEN/ DATES/ TOTAL NUMBER OF HOURS

_________________________________________________________________________ COURSE TITLE/WHERE TAKEN/ DATES/ TOTAL NUMBER OF HOURS

_________________________________________________________________________ COURSE TITLE/ WHERE TAKEN/ DATES/ TOTAL NUMBER OF HOURS

_________________________________________________________________________ COURSE TITLE/ WHERE TAKEN/ DATES/ TOTAL NUMBER OF HOURS

Courses in Latin

_________________________________________________________________________ COURSE TITLE/ WHERE TAKEN/ DATES/ TOTAL NUMBER OF HOURS _________________________________________________________________________ COURSE TITLE/ WHERE TAKEN/ DATES/ TOTAL NUMBER OF HOURS _________________________________________________________________________ COURSE TITLE/WHERE TAKEN/ DATES/ TOTAL NUMBER OF HOURS _________________________________________________________________________ COURSE TITLE/ WHERE TAKEN/ DATES/TOTAL NUMBER OF HOURS

All other Classics courses _________________________________________________________________________ COURSE TITLE/ WHERE TAKEN/ DATES/ TOTAL NUMBER OF HOURS _________________________________________________________________________ COURSE TITLE /WHERE TAKEN/ DATES/ TOTAL NUMBER OF HOURS To enter this certificate program, the student should send the following:

Completed application form College or university transcript, with date of actual or expected B.A. degree clearly indicated Statement of purpose (one typed page) Two letters of recommendation from college or university instructors $45 nonrefundable application fee, payable to: Regents of UC The University of California, in accordance with applicable Federal and State Law and University policy, does not discriminate on the basis of race, color, national origin, religion, sex, disability, age, medical condition (cancer-related), ancestry, marital status, citizenship, sexual orientation, or status as a Vietnam-era veteran or special disabled veteran. The University also prohibits sexual harassment. This nondiscrimination policy covers admission, access and treatment in University programs and activities.

Inquiries regarding the University's student-related nondiscrimination policies may be directed to Office of the Dean, University Extension, (530) 757-8663. .

The material should be sent to: Post-Baccalaureate Certificate in Classics, Registration Office, UC Davis Extension, University of California, 1333 Research Park Drive, Davis, CA 95616-4852

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