CENTER for CIVIC ENGAGEMENT
Civic Engagement Certificate Application
Return to 222 Nebraska Union
Contact & Personal Information
Name: _________________________________
Student ID #: __________________________
Campus Address: __________________________________________________________________
Campus Zip Code: ______________________
Cell Phone #: ___________________________
E-mail Address: ________________________
Home Address: ___________________________________________________________________
City, State, & Zip Code: ____________________________________________________________
Parent(s)/Guardian(s) Name(s): ______________________________________________________
Hometown Newspaper: ___________________________________________________________
T-shirt Size: __________
Education Program Information
Major: __________________________________
College: ______________________________
Academic Advisor: ________________________________________________________________
# of Credit Hours Completed: _______________
Estimated Grade Point Average: ___________
Proposed Graduation Month & Year: __________________________________________________
In order for staff to know you better, please attach the following documentation:
1. Current Resume
2. Civic Engagement Essay. In less than 500 words, describe what civic engagement means to you,
how you have been civically engaged in your community, and what you hope to gain through
completion of a civic engagement certificate.
If you have questions regarding this application and/or the Civic Engagement Certificate, please contact:
Dr. Kris Baack
Dr. Linda Moody
Linda Major
402.472.8152
402.472.8158
402.472.6536
kbaack1@unl.edu
lmoody2@unl.edu
lmajor1@unl.edu
222 Nebraska Union
Lincoln, NE 68588-0444
402-472-6150 www.unl.edu/engage