Application for the Peace and Urban Certificates
Urban Center for Peace

Complete and Press Submit when finished

* Note this is not a secure web application. If you have concerns about this information being submitted electronically, please go to the printer-version and send via mail.

Date (mm/dd/yyyy)

First Name Last Name

SSN (No Dashes or Spaces - ex: 123456789)

Country of Citizenship (if non-U.S.)

Telephone (ex: xxx-xxx-xxxx)

Address Information ** Include street adress. city, country (if non-US) and postal code

Email Address (ex: anyone@anywhere.com)

Websites that you want to reference us to (Include those which you designed):

Highest Level of Education High School Bachelor's Degree Masters Degree Doctoral Degree Other
Type of Degree (e.g. diploma, degree, certificate, etc.) Diploma Degree Other
Degree Objectives Bachelors Post-Bachelors Work Masters Doctorate Certificate(s) Only

Are you currently applying to a degree program at UC? Yes No
If yes to either question, which one?

What is your educational background? (include all education and dates attended)

What is your career/occupational background?
(List company names, your responsibilities and dates employed within last 5 years)

What are your career objectives?

What are your reasons for pursuing the Peace Education Certificate
(be as thorough as possible)?