Application to Follow a Certificate in Counselling and Mental Health

Students completing an Honours BA or BSc within the Department of Psychology are expected to apply prior to completing 36 credits and after completing 24 credits including PSYC1010 6.00.

Student Number: *
Student's Surname: Student's Surname: First Last
Student's First Name: Student's First Name: First Last
Telephone Number: Telephone Number: * - ### - ### ####
York University Email: *
Home Faculty:
Anticipated Graduation Year: *
Number of Credits completed so far? *
Number of Credits in progress (potential): *
Degree Type: *
Graduating Program of Study (choose one): *
NOTE: By completing and signing this form you
consent to the use and disclosure of your personal
information by York University as outlined above.

Student's Signature: *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / DD / MM YYYY