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

L&C Email

Register using your L&C Email address only
(This is required for all class registrations and communications. The Registrar will not process registrations submitted with personal email addresses).

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 2025 Courses

Payment notifications for Summer 2025 courses will be issued in late April 2025 (when the payment portal opens for Summer). Please submit payment after receiving a payment notification from cce@lclark.edu. Please make payment in full or establish a payment plan within 2 business days of receiving a payment notification from cce@lclark.edu to secure your registration.

Continuing Education Tuition and Costs

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

White	Black or African American	American Indian/Alaska Native
Asian	Native Hawaiian or other Pacific Islander	Other
Decline to Report