Global Experience Certificate Plan
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1
2Global Experience Certificate Plan
Waterloo International
East Campus 3 – First Floor
Instructions:
Waterloo, Ontario, Canada
1.
Complete and sign this form and create an academic calendar (template online).
N2L 3G1 519‐888‐4567, ext. 38350
2.
Email this form and your academic calendar to studyabroad@uwaterloo.ca.
Fax: 519‐888‐4355
3.
Students are responsible for notifying
studyabroad@uwaterloo.ca
of any changes to their GEC
plan or academic calendar.
ID Number:
Surname: _________________________________ Given Names: ___________________________________________
Canadian Citizen
Permanent Resident
International Student
Address: _________________________________________________________________________________________
City: __________________________ Province: ______ Country: _____________________ Postal Code: ___________
Home Phone: ____________________ Cell Phone: _____________________ Email: ___________________________
Faculty: ____________________________ Program: _____________________________________________________
Option/Minor/Specialization: _______________________________________________
Co‐op
Regular
Current Academic Level: ____________ Expected Convocation Date: _____________________
Section A – Language and Global Studies Course
Choose two (2) first year sequential language courses (other than your native language) AND one Global Studies course.
____________________________ ____________________________
____________________________
Language
Language
Global Studies Course
Section B – International Experience
(minimum 6 consecutive weeks in duration)
Select the appropriate box:
Exchange
Study Abroad
Work Term
Volunteer
Internship/Externship
(Co‐op Only)
(Outside Co‐op)
________________________
________________________
________________
___________________________
Approximate Start Date
Approximate End Date
Country
Institution/Organization
Section C – Cross Cultural Volunteer Experience
(minimum 20 hours during one academic term)
Select the appropriate box:
On campus
Waterloo International Programs
University College Programs
Other
(Requires approval)
________________________
________________________
__________________________________________
Approximate Start Date
Approximate End Date
Institution/Organization
____________________________ __________________________________________________________________
Country
Program Name
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Waterloo International December 2014
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