1. Name:

2. Address:

(City) (State) (Zip)

3. Phone: (home)   (cell)

4. Email: (MEID if available)

5. Degrees Earned: None AA BS/BA Doctorate

6. Current Certifications and Licenses: (if any)


7. Number of semesters completed:

8. Number of credits completed: GPA: 

9. Please check each of the Certificate Program requirements* that you have completed.

  Code Title Credits
HES 100 Healthful Living 3
PED 101,102,201,202 Chi Kung, Tai Chi, Yoga 2
SOC 270 Sociology of Health & Illness 3
WED 105 Minimizing Workplace Stress 0.5
WED 151 Overview of Alternative Medicine 3
WED 162 Meditation and Wellness 1
WED 257 Kinetic Meditation 2
WED 258 Auditory Meditation 2
WED 259 Visual Meditation 2
WED 275 Practicum 3
    Total Credits Completed: 0
  * Please see the Program Brochure and College Catalog for complete program requirements. 

  

10. Would you like to schedule an appointment to speak with the Program Coordinator? Yes    No