Technology and Society Emphasis - Intent to Enroll Name Department E-mail PERM Please list the courses you plan to take or have already taken to fulfill the T&S Emphasis requirements. A grade of B or better is required in each course (note grade if course is already complete). Note: Any courses that are NOT currently listed at http://cits.ucsb.edu/requirements will require an approved petition to count toward the Emphasis (see website for Course Petition Form), even if courses were listed on prior CITS websites. Title Instructor Qtr/Yr Petition* Grade Area 2: Society & Behavior Area 1: Culture & History Course # Technology & Society Gateway Seminar * Check the box if this class is NOT currently listed on the T&S Emphasis Requirements page and you have petitioned or will petition for it to count toward the Emphasis. I will choose at least one dissertation committee member who is a Technology and Society Affiliate Faculty member from outside my home department. A list of eligible faculty can be found at http://cits.ucsb.edu/education. My dissertation will reflect at least one of the Technology and Society Emphasis Areas. Student Signature Date Home Department Faculty Advisor Signature Date Once you have completed your coursework and defended your dissertation, submit the Emphasis Completion Form to declare your dissertation topic, committee, and any changes to your coursework. T&S Director Signature: Date: