2019-2020 Delegate Certification Form
Welcome to the Graduate Assembly! If you have been selected to serve as a Graduate Assembly Delegate or Alternate for your academic department, group, or program, please fill out this form.

Email *
Part 1: Delegate Information
Name *
Department, Group or Program *
Degree Type *
e.g., PhD, MA, MPP, JD, etc.
Estimated Year of Graduation *
Berkeley Email *
Contact Phone # *
I am applying to be a: *
New Delegates and Alternates are required to attend a New Delegate Training Session in August or September (dates and times TBD).
Please list any internal, campus, or academic committees you already sit on or have served on in the past, if any.
These may count toward your Delegate committee requirement.
Are there any internal, campus, or academic committees that you would like to sit on?
We will take these into account while assigning delegates to committees.
Do you have any dietary restrictions? *
Required
Preferred Gender Pronouns
e.g., he/him/his, she/her/hers, they/them/theirs, etc.
Please select the issues of particular interest to you.
This will assist the GA in better placing you on internal and/or campus committees.
Please mark your first choice. *
Please mark your second choice.
Please mark your third choice.
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