BA Preceptorship Application

2021-22 CSGS BA Preceptor Application

Due February 28, 2021
Personal Information
Full Name *

First Name Last Name
Preferred name
Preferred pronouns *
UC ID number *
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Academic Information
Department *
Year you began program *
List other fellowships or grants you are applying to for the upcoming year. *
Please list undergraduate and graduate courses you have taken which may be relevant to this position *
Recommender Information

FYI - Your recommender will receive an email with instructions for submitting a letter. They will have until 3/7/2021 to submit.
Recommender name *

First Name Last Name
Recommender email *
example@example.com
Additional Documents
Two page CV *
Cover letter specifying the nature of your preparation for the Gender and Sexuality Studies BA preceptorship *
Should be Empty:

2021-22 CSGS BA Preceptor Application