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Application: Certificate in Introductory Studies in Dance/Movement Therapy
Department of Dance, University of Wisconsin-Madison
Declaration of Intent to Declare or to Cancel Certificate (Cert 399)
An advising session with the coordinator/advisor for the certificate program, Rena Kornblum, is strongly recommended before declaring this certificate. Contact Ms. Kornblum at email@example.com.
Student ID Number:
Email address (must be wisc.edu address)
I DECLARE my intention to pursue the Certificate in Introductory Studies in Dance/Movement Therapy.
I CANCEL my declaration to pursue the Certificate in Introductory Studies in Dance/Movement Therapy.
Direct questions about this certificate to the program coordinator, Rena Kornblum, at firstname.lastname@example.org.
Direct technical questions about declaring or canceling your declaration of this certificate to email@example.com.
Upon completion, you must submit an electronic completion form for this certificate. Find the Dance certificates completion form here:
Submit the completion form during the semester you finish the required certificate course work or during the semester you intend to graduate.
By pressing submit, I verify that I have read the information above. Print a copy of this application before submitting and retain for your records.
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