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Gerontology Certificate Application

Please submit the Gerontology Certificate Application form to apply online.

*Required

Personal Information

*First Name:

*Last Name:

*A Number:

*Address:

*City:

*State:

*Zip:

*Phone:

*Permanent Address:

*Permanent City:

*Permanent State:

*Permanent Zip:

*Permanent Phone:

*Email:

Academic Information

*Major:

Minor(s):

*Year In School:

*Overall GPA:

(must be 3.0 or above)

*Expected Graduation Date:

(Semester/Year)

Certification Requirements

Please enter the following semesters you have taken these courses, or enter the semester in which you plan to take the course

Required Coursework
(10 credits)

Semester Taken/Plan To Take - (Semester/Year)

FCHD 3540 Adult Development and Aging

FCHD 4240 Social and Family Gerontology

or NFS 4480 Community Nutrition

FCHD 4970 Gerontology Practicum (150 hours)

Please list the kinds of facilities you may want to work at for your practicum:

FCHD 4940 Gerontology Integration Paper

The gerontology Practicum paper has to be taken the same semester as the practicum or afterward – it cannot be taken before the practicum

Elective Coursework
(6 credits)

Semester Taken/Plan to Take - (Semester/Year)

Please see the list of elective courses online, and the requirements described there before filling out this section

COMD 2910 Sign Language I (3)

FCHD 3340 Housing: Societal & Environmental Issues (3)

FCHD 3350 Family Finance (3)

HEP 3200 Consumer Health (3)

HEP CI 3600 Introduction to Community Health (3)

HEP CI 5000 Race, Culture, Class, & Gender Issues in Health(3)

MUSC 3320 Psychology of Music I (2)

NFS 2020 Nutrition Through the Life Cycle (3)

NFS 4540 Nutritional Assessment (3)

NFS 4550 Clinical Nutrition I (3)

NFS 5200 Nutritional Epidemiology (2)

NFS 5630 Nutrition in Aging (3)

PHIL 3500 Medical Ethics (3)

POLS 3810 Introduction to Public Policy (3)

PRP 3100 Leisure and Aging (2)

PRP 4500 Diverse Populations (3)

PSY 1210 Human Adjustment (3)

PUBH 3120 Family and Community Health (3)

SOC 3200 Population and Society (3)

SOC 3330 Medical Sociology (3)

SOC 3600 Sociology of Urban Places (3)

SOC 6460 Sociology of Health (3)

SW 3550 Social Gerontology(3)

SW 3750 Medical Social Services (3)

SW 4900 Special Topics (if related to Aging) (3)

Essay:

In several paragraphs, please describe the following:

Why have you chosen to complete the Gerontology Certificate?
What are your career and educational goals?
What past exposure have you had to gerontology?