ArtPHIL STUDENT PROGRAM COMPLETION FORM

Advanced Graduate Certificate

in Art and Philosophy

Program Completion Form

Please fill out the following information and press the SUBMIT button at the bottom of the page.

Items with an asterisk (*) are required. Enter "none" if not applicable.

The confirmation page will follow indicating that your form has been submitted.

* ArtPHIL ADVANCED GRADUATE CERTIFICATE (AGC) STUDENT - PROGRAM COMPLETION FORM *

PERSONAL INFORMATION

*Last Name

*First Names

*Your E-mail

*Your Student ID Number

*Primary Degree Program

*Primary Department

If other, please specify:

*Enter Academic Year you first matriculated in the current Stony Brook primary degree program

*Enter Academic Year when you received permission from the Graduate School to enroll in the Art and Philosophy Graduate Certificate.

*Previous Institution(s) - indicate College/University, Degree, and Dates of Attendance

1.

2.

3.

4.

5.

CONTACT INFORMATION - STONY BROOK CAMPUS

Campus Building

Campus Room Number

CONTACT INFORMATION - PERMANENT HOME ADDRESS

Street

Apt or Other

City

State/Province

Postal/Zip Code

Country

CONTACT INFORMATION - LOCAL HOME ADDRESS

Street

Apartment or Other

City

State/Province

Postal/Zip Code

Country

*Primary mailing address
*

*Re-enter E-Mail

CONTACT INFORMATION - TELEPHONE NUMBERS

Stony Brook Office Telephone

Local Home Telephone

Mobile Phone

Permanent Home Telephone

COURSES COMPLETED

1- Joint Art-Philosophy Seminar

Dept Number & Title (Professor[s])

Semester

2- Art Course Number & Title (Professor),

Semester #1

3- Art Course Number & Title(Professor),

Semester #2

4- Philosophy Course Number &Title (Professor),

Semester #1

5- Philosophy Course Number & Title (Professor),

Semester #2

ALT- If substituting CLT or other seminar for one of above, indicate Course Number & Title (Professor),

Semester #1

OTHER RELEVANT COURSES OUTSIDE PRIMARY DEGREE PROGRAM

1- Additional Course Number & Title (Professor),

Semester

2- Additional Course Number & Title (Professor),

Semester

3- Additional Course Number & Title(Professor) ,

Semester

Any additional comments

Today's Date:

Make sure that all your information is correct.

Once you press the SUBMIT button, your information will be delivered to Professor Hugh J. Silverman, Advanced Graduate Certificate in Art and Philosophy Program Director.

The CLEAR botton will erase all information and you will have to start again.

ArtPHIL Graduate Certificate Program Director

Prof. Hugh J. Silverman

Professor of Philosophy, and Comparative Literary and Cultural Studies

Stony Brook University, Stony Brook, NY 11794-3750 USA

hugh.silverman@stonybrook.edu

PERSONAL INFORMATION
*Last Name
*First Names
*Your E-mail
*Your Student ID Number
*Primary Degree Program
*Primary Department	If other, please specify:
*Enter Academic Year you first matriculated in the current Stony Brook primary degree program
*Enter Academic Year when you received permission from the Graduate School to enroll in the Art and Philosophy Graduate Certificate.
*Previous Institution(s) - indicate College/University, Degree, and Dates of Attendance	1. 2. 3. 4. 5.
CONTACT INFORMATION - STONY BROOK CAMPUS
Campus Building
Campus Room Number
CONTACT INFORMATION - PERMANENT HOME ADDRESS
Street
Apt or Other
City
State/Province
Postal/Zip Code
Country
CONTACT INFORMATION - LOCAL HOME ADDRESS
Street
Apartment or Other
City
State/Province
Postal/Zip Code
Country
*Primary mailing address	*
*Re-enter E-Mail
CONTACT INFORMATION - TELEPHONE NUMBERS
Stony Brook Office Telephone
Local Home Telephone
Mobile Phone
Permanent Home Telephone
COURSES COMPLETED
1- Joint Art-Philosophy Seminar Dept Number & Title (Professor[s]) Semester
2- Art Course Number & Title (Professor), Semester #1
3- Art Course Number & Title(Professor), Semester #2
4- Philosophy Course Number &Title (Professor), Semester #1
5- Philosophy Course Number & Title (Professor), Semester #2
ALT- If substituting CLT or other seminar for one of above, indicate Course Number & Title (Professor), Semester #1
OTHER RELEVANT COURSES OUTSIDE PRIMARY DEGREE PROGRAM
1- Additional Course Number & Title (Professor), Semester
2- Additional Course Number & Title (Professor), Semester
3- Additional Course Number & Title(Professor) , Semester
Any additional comments
Today's Date: