Criminal Justice Certificate

Application Form

Applicants: Please complete this form, and send to Sociology Advising,
Department of Sociology, University of Massachusetts,
712 Thompson Hall, 200 Hicks Way, Amherst MA 01003-9277,
fax to 413 545-3204 or carvajal@soc.umass.edu

NAME ______________________________________________________________
Last First Middle Initial

Address ______________________________________________________________
Street Apt. City State ZIP Country

E-mail _______________________________ Phone ___________________________

CHECK ONE AREA:

On-line students attending through Continuing & Professional Education (CPE)
Admission requires a High School Degree, GED or international equivalent

Prior Education (complete all that apply)
US High School Degree (School and date)_____________________________________
US GED (Issued by and date)_______________________________________________
Non-US Secondary School completion (School and date)_________________________
Community College Coursework (Schools and credits)___________________________
Four year/Tertiary degree (School and major)___________________________________
Advanced degree (School and field)__________________________________________

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Matriculated, 4-year degree students, current students at UMass Amherst

Student ID no.:__________________Expected year of graduation:_________________

Primary Major: _________________Secondary major:___________________________



Upon completion students are required to complete a CJ Certification completion form
for certification. Forms can be obtained in the Sociology Department, 712 Thompson
Hall or through www:umass.edu/sociol/umdergraduate