First Name

Last Name

Address

Address 2

City

State

Zip Code

Phone

E-mail

Affiliation

Select one Graduate Student Fellow Academic Professional

Degree Program

Research Interest

How did you learn about the CEM program

Please write an interest statement describing why you would like to enroll in CEM (50 words or less)

Scholarship and Internship:  if interested, complete the online registration form for the CEM program.  Apply for scholarship, internship, or both.

If you are interested in applying for a CEM scholarship, please complete the online registration form, the scholarship application, and submit both by December 15, 2011. Scholarship applicants, please omit your tuition payment until scholarship recipients have been confirmed; notifications will be sent via email by December 31, 2011. Scholarship amounts up to 50% of the tuition for the course will be granted.

Scholarship deadline: December 15, 2011

Internship deadline: March 1, 2012
Apply for internship here.

Select one Scholarship Internship

Payment Type

Select one Credit/Debit Card CFOP Check

CFOP

Activity Code