MLCS Additional Portfolio Module Request

For modules beyond your required number, fill out this form in addition to the Portfolio Module form used to plan out a Module. Submit both completed forms to the Graduate Advisor.

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Name:	Click to enter your name.

ID:	Click to add your ID.

Degree (double click box & select ‘checked’):

MA-Course

MA-Thesis

PhD

Stream (double click box & select ‘checked’):

Applied Linguistics

Media & Cultural Studies

Translation Studies

Transnational & Comparative Literatures

Current Year of Study:	Click to enter Term & Year.

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Additional Module (double click box & select ‘checked’):

Academic Service

Community Service Learning

Conference Presentation

Data Collection

Digital Creation

Exhibition, Performance, or Creative Work

Public Scholarship, Literary Journalism, or Creative Nonfiction

Review Article

Teaching Portfolio (extension of MLCS 650)

Teaching Workshops

Translation

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I. Justification: Why would you like to complete this additional module?

Click here to respond.

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II. Timeline: Describe how this additional task may affect your time to completion. What steps will you take to assure you remain within your expected timeline?

Click here to respond.

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III. Signatures:

Student:	Click here (typed signature is fine).	Date:	Click here to enter date.

Mentor:	Click here (typed signature is fine).	Date:	Click here to enter date.

Thesis Supervisor:	Click here (typed signature is fine).	Date:	Click here to enter date.
(if applicable)