Professional Writing Certificate Program Enrollment Form

To enroll in the Professional Writing Certificate program, you must have completed the first year of college English or the equivalent (credit, transfer credit, or credit by exam), and you must submit the following application form for our files.

A few days after you submit the form, you will receive an e-mail response notifying you of your status in the program.

Note: You must register for classes at the McKimmon Center. This form does not register you for classes. This form enrolls you with the English Department only.

1. Date (mm/dd/yy):

2. Last Name: First: MI:

3. Address: City: State: Zip:

4. Phone #: (Home) (Work)

5. Email Address:

6. How did you hear about the Professional Writing Certificate (check all that apply)?

a friend or acquaintance

information at my place of employment

inquiries through the NCSU Division for Lifelong Education

inquiries through the English Department

other (internet)

7. A prerequisite for the Professional Writing Certificate Program is to have completed the first year of college English or the equivalent (credit, transfer credit, or credit by exam). List here any college English courses you have had. Please indicate also where you took these courses.

8. Do you currently hold any degrees? Yes No

If yes, complete the following:

Degree Name (highest):

Degree Date:

College or University:

9. When do you plan to complete the requirements for the Certificate in Professional

Writing?

Year Semester

10. Briefly describe your career goals: