Application Form

First Name

Last Name

Street Address

City

State/Province

Zip/Postal Code

Country

Email Address

Telephone (day)

Telephone (other)

Please list any previous education and/or experience in the digital arts field.

A 300 word written essay is required to complete your application. The subject is "Why I choose to attend the Digital Arts Center at UC San Diego Extension." You can paste your essay in the box below (please, no html formatting) or you can email your essay to dac@ucsd.edu.

How did you hear about the Digital Arts Center program?

I am aware that while participating in field trips, off-campus residential programs, non-Extension sponsored events, athletics and other out-of-class activities under the auspices of the Professional Certificate Program, certain risk and dangers may occur. These dangers include, but are not limited to: accident or illness without readily available medical facilities, the forces of nature, and/or travel by automobile, bus, or other conveyance.

In consideration of the right to participate in such out-of-class activities arranged by the Professional Certificate Program, I do hereby assume all the above risks and will hold the Regents of the University of California, and their officers and employees, harmless from all liability which may arise in connection with my participation in the activities arranged by the Professional Certificate Program during my enrollment.

Name

Relationship

Telephone

Email Address

Upon your acceptance into the UC San Diego Extension DAC program, a non-refundable $150 registration fee will be required.

Please review all information entered before submitting your application.