PROJECT NATURECONNECT
.....Applied Ecopsycology/Integrated Ecology
.....ORIENTATION
COURSE
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Elements of Global Citizenship:
Orientation Course PSU Credit Application Form Instructions: Print out this
form and Postal Mail it to
Psychological Elements
of Global Citizenship
COURSE CREDIT APPLICATION FORM This form is to be printed out, completed and POSTAL MAILED after you have completed a course including your evaluation form. Do not send this form in before completing the course.
PORTLAND STATE REGISTRATION FORM FOR PROJECT NATURECONNECT COURSE CREDITS Continuing Education in the Graduate School of Education (CEED)
PLEASE SEND THE FOLLOWING INFORMATION AND PAYMENT BY CHECK made out to Project NatureConnect
COURSE AND CREDIT INFORMATION ( )Psychological Elements of Global Citizenship 1 Credit ( )Other course and credits needed ( )Other course and credits needed
DATE SOCIAL SECURITY NUMBER LAST NAME FIRST NAME MIDDLE INITIAL PREVIOUS LAST NAME MAILING ADDRESS ZIP, STATE HOME PHONE ( ) DAY PHONE ( ) EMPLOYER POSITION CHECK THE FOLLOWING ( )FEMALE ( )MALE ( ) USCITIZEN ( ) PERMANENT U.S. RESIDENT ( ) STUDENT VISA BACHELOR'S DEGREE ( ) YES ( ) NO DATE OF BIRTH TERM ( )FALL ( )WINTER ( )SPRING ( )SUMMER YEAR: COURSE TITLE leave blank if unknown COURSE REFERENCE. NUMBER (CRN select one: DEPARTMENT AND NUMBER ( ) CI (CURRICULUM INSTRUCTION-EDUCATION COURSE? OR ( ) COUN (COUNSELING COURSE) ( ) GRADUATE OR ( )UNDERGRADUATE ( ) CREDITS ( ) FEE ( ) FIRST PSU OR CONTINUING EDUC REGISTRATION ( ) CONTINUING FROM LAST TERM ( ) RETURNING AFTER AN ABSENCE (LAST TERM ATTENDED__________ PAYMENT METHOD ( ) CHECK Payable to Project NatureConnect (for credit at $42/credit.) You should have paid for the course by this time. If not, submit payment with this form along with an explanation of the delayed payment.
Dr. Michael J. Cohen, Director P. O. Box 1605, Friday Harbor, WA 98250 nature@interisland.ne
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