Student Information

First Name*

Last Name*

Preferred Name / Nickname

Email*

Princeton I.D. Number*

Class Year*

Major / Department*

AB of BSE Degree? (Select One)*

AB

BSE

Residential College*

Butler

Forbes

Mathey

New College West

Whitman

Wilson

Yeh College

Certificate Program Selection

Certificate Program*

Energy

Information Technology

Have you taken (or are you currently enrolled in) the coure course EGR 277: Technology and Society?*

Yes

No

Please list any other relevant courses you have taken that would satisfy the requirements of this certificate program. (Note: a list of courses is available in the Requirements section of the website)

Academic Adviser

How did you learn about the Certificate Program in Technology and Society? (Please check all that apply)*

Andlinger Center for Energy and the Environment

Center for Information Technology (CITP)

Email from Dean Bogucki/Traci Miller

Friend/Classmate/Professor

Keller Center

Other

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