North Carolina Agricultural and Technical State University
Interdisciplinary Waste Management Institute

 Application for a Waste Management Certificate

"Highlighting your training in Waste Management and Environmental Issues"

Name: __________________________________________________________________
Type/Print full given name which will appear on your certificate.

Social Security Number:____________________________________
School/College:_________________________________________ Major: Nursing
Agric., Arts & Sci., Educ., Bus. & Econ., Engr., Nurs., Technology
Degree: BSN Date Completed/Expected__________
Have you applied for graduation? ___Yes ___No

Students will receive the certificate at a special ceremony upon the completion of the undergraduate degree. You will have to reapply for WMI Certificate if you fail to meet graduation requirements.

I wish to complete the requirements for a waste management certificate:

____Fall ____ Spring ____First Summer ____ Second Summer_____

 A. List of Environmental/Waste Management courses completed and in progress:



EASC 201, BIOL 220, CHEM 104, CHEM 114, NURS 510, PSYC 320, NURS 320, NURS 410, NURS 411, NURS 511, NURS 510 and Special Projects in Environmental issues.

Total Credit Hours:_________________GPA:___________

B. Other Environmental/Waste Management experiences (internships, projects completed, volunteer work, etc.) Attach a statement.

 
I understand that to earn a certificate in waste management for the semester/summer indicated above, I must have completed a minimum of 18 credit hours of approved waste management/related courses, and have a minimum GPA of 2.0.

Local Address: ____________________________________________________________
Street/Apt.#. City and State/Zip Code
Local Phone Number:__________________ E-mail Address________________________
Permanent Address: ________________________________________________________
Street/Apt.#, City and State/Zip Code
Home Phone Number: ________________
Applicant Signature:_____________________________________ Date:______________
Waste Management Director Signature:___________________________ Date:_________

Submit Completed Application by ________________, 2003:

 Waste Management Institute
Carver Annex
Incomplete applications will be rejected.
(336) 334-7030 Fax (336) 334-7399
uzo@ncat.edu www.ncat.edu/~wmi for courses.