Foundations of Graduate Health and Wellness Program Interest Form
This form is for UCI graduate students and post-doctoral scholars interested in the Foundations of Graduate Health and Wellness Program, which will be facilitated by Graduate Division Counselor Phong Luong, Psy.D. You will receive a certificate upon successful completion of the program.
Full Name: *
Your answer
Nickname:
Your answer
UCI ID Number *
Your answer
UCI Email: *
Your answer
Phone Number: *
Your answer
Local Address: *
Your answer
Please select one: *
Academic School: *
Program (Graduate Students) or Position (Postdoctoral Scholars): *
Your answer
Year in your program/position: *
ex. 5th
Your answer
What made you interested in the Graduate Health and Wellness certificate program? *
Your answer
Please describe previous health and wellness activities you have engaded in: *
Your answer
Please describe the challenges you face in reaching your health and wellness goals: *
Your answer
What skills do you wish to learn? *
Your answer
How did you hear about this program? *
Your answer
Which series are you applying for? *
AGREEMENT *
By checking both boxes you are confirming you have read and agree to both statements.
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