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Gender Diversity Certificate Application

Please note: This application form is for candidates who do not have a bachelor’s degree. If you hold a bachelor’s degree, please apply via the application portal here.

Application to this program requires a $50 application fee, which can be payable here. Your application will not be reviewed until payment is completed. 

Lewis & Clark employees and members of service organizations are eligible for a fee waiver. Learn more here, and contact cce@lclark.edu to request a fee waiver.

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All fields marked with asterisk (*) are required.

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Name
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Address
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Additional Information

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Gender and Personal Pronouns
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What pronouns do you use?*
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Language(s)
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Additional Questions
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Are you a first generation college student?*
Answer “no” if any of your parent/guardians graduated with a degree from a 4-year college/university or the foreign equivalent
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Are you currently employed at Lewis & Clark?*
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Have you previously applied for admission to a Lewis & Clark Graduate program?*
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Are you currently attending or have you previously attended Lewis & Clark? This includes degree, license, endorsement, or certificate programs?*
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Biographical Information

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Demographic Information

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Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

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Are you Hispanic or Latino?
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In addition to your answer to the prior question, please check one or more of the following groups in which you consider yourself to be a member:
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Resume

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Provide a current professional resume listing positions that you have held for three months or longer, including your present position. List any volunteer work or other professionally related experiences, as well as any scholastic or academic honors, fellowships, or scholarship received.
(50 MB max)
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Gender Diversity Certificate Essays

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Intended students for this certificate program include educators across all grade levels, schools and district administrators, school counselors and psychologists, mental health professionals that work with schools and youth serving organizations, school board members, civic officials, and other professionals and community members engaged in advocacy work on behalf of/serving gender diverse, transgender, nonbinary and/or queer students and adults.

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(50 MB max)
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Center for Community Engagement is located in Rogers Hall on the Graduate Campus.
MSC: 85

email 

voice 503-768-6040 
fax 503-768-6045 

Director Matsya Siosal

  • Center for Community Engagement
    Lewis & Clark
    615 S. Palatine Hill Road MSC 85
    Portland OR 97219