Name Field of Study Are you a public humanities certificate student? Yes No Name of Micro-Credential or Internship Instructor of Micro-Credential or Advisor of Internship Dates of attendance Start Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 End date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Did you miss any classes? Yes No If yes, please explain. Please describe the work you completed for the micro-credential or internship Other Comments CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.