CENTER FOR COMMUNITY ENGAGEMENT LEWIS & CLARK GRADUATE SCHOOL OF EDUCATION AND COUNSELING

Eating Disorders Certificate Program

The Following Information is Required

Legal Name: First

Last/Family

Chosen First Name

Chosen Last Name

Former Names

Address

Street Address

City

State

Zip

Phone

HomeCellWork

Please register using your L&C Email address
(this is required for all class registrations and communications).

Date of Birth

Social Security Number

L&C ID (if known)

If not a citizen of the U.S. are you a Permanent Resident?

Yes

Visa type:

The Following questions are optional

How do you describe your gender identity?

Pronouns

How would you describe your race? Are you Hispanic/Latino?

YesNo

Course Selection

This form is for continuing education courses only. These courses are not degree-applicable and offered only as pass/fail (CR/NC). Letter grades are not provided.

Term

Course Title & Start Date (YYYY-MM-DD)

Course #

Course Cost

You are responsible for all tuition and fees for any course,

workshop, event, or conference for which you register.

CCE will email you to complete your payment once your registration is processed.

Total Due: $

Summer 2024 Courses

Please do not submit payment for Summer 2024 courses until you receive a payment notification from cce@lclark.edu (starting April 2024). Payment is due within 2 business days of receiving the payment notification.

Accessibility

If you have a disability that may impact your academic performance, you may request accommodations by meeting with the Office of Student Accessibility staff and submitting documentation on the Office of Student Accessibility website. Please be aware that the process for evaluation and implementation of accommodations could take 2-3 weeks so please be in touch with the Office of Student Accessibility as soon as possible. Email access@lclark.edu with any additional questions or concerns.

COVID-19 Information

https://www.lclark.edu/news/covid-19-response/

Center for Community Engagement - Lewis & Clark Graduate School of Education and Counseling 615 S Palatine Hill Rd, MSC 85, Portland, OR 97219-7899
Phone: 503-768-6040 | Email: cce@lclark.edu
go.lclark.edu/graduate/cce

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