Intercultural Competence and Communication Program - Grand Valley State University

Intercultural Competence Certificate Application

Personal Information

First Name: *

Middle Name:

Last Name: *

Email: *

G-number: *

Major: *

Expected Graduation Date: *
Month: Day: Year:

Gender:

Date of Birth: *
Month: Day: Year:

Ethnic Background:

Contact Information

Local Contact Information

Local Address 1: *

Local Address 2:

Local City: *

Local State: *

Local Zip Code: *

Local Phone: *

Permanent Contact Information

Permanent Address 1: *

Permanent Address 2:

Permanent City: *

Permanent State: *

Permanent Zip Code: *

Permanent Phone: *

ITC Course Completion Plan

ITC 100

Year Course Taken/Will Take: *

Semester Course Taken/Will Take: *

Course Grade (If Already Taken):

ITC 490

Year Course Taken/Will Take: *

Semester Course Taken/Will Take: *

Course Grade (If Already Taken):

Will you combine ITC 490 with study abroad?

ITC 495

Year Course Taken/Will Take: *

Semester Course Taken/Will Take: *

Course Grade (If Already Taken):

Elective 1

Elective Course Name: *

Year Course Taken/Will Take: *

Semester Course Taken/Will Take: *

Course Grade (If Already Taken):

Elective 2

Elective Course Name: *

Year Course Taken/Will Take: *

Semester Course Taken/Will Take: *

Course Grade (If Already Taken):

Additional Information

Please discuss the experiences and interests that have led you to choose to pursue the Intercultural Competence Certificate (200 words or less) *

Review the list of electives approved for this certificate. Identify one of the categories that best fits your academic and professional interests. Describe how you believe intercultural competence is relevant to that category. (200 words or less) *

Review the three tracks for the Practicum course listed here: https://www.gvsu.edu/itc/completing-the-certificate-9.htm After selecting one, describe why you selected that track and discuss the kinds of immersive experiences you are interested in completing for the course. (200 words or less)*

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