SOCIAL SCIENCE SUBJECT MATTER PREPARATION PROGRAM

Please complete this form to request a Certificate of Social Science Subject Matter Preparation Program Proficiency.

This form must be submitted by the deadline to submit the application for graduation. If you have any questions regarding the program requirements, please contact the department. Only one certificate will be issued.

*** Please note that all fields are required. ***

First Name:
Last Name:
Department:
Local Street Address:

City:
State:
Zip:
Telephone Number: 123-456-7890 format
Graduation Quarter:
Student Identification Number:
E-Mail Address:
Will you be entering UCR's Credential Program?	Yes No
If you answered “yes” to this question, then your certificate will be mailed directly to the Teacher Credentialing Services after all of your grades have been received and you are cleared for graduation.
Are you attending another institution?	Yes No
If so, your certificate will be available for pick up after all of your grades have been received and you are cleared for graduation.