Health Humanities Diploma Request Form

First Name *

Last Name *

Student ID Number *

Waterloo Email *

Faculty *

Academic Program *

Academic Plan(s) - list all majors, minors, options, specializations, etc. *

I am declaring *

Confirmation of Information

I have read and am fully aware of the requirements to graduate with the Health Humanities Diploma as stipulated on the Undergraduate Calendar.

I confirm that the information provided here is accurate, correct, and complete.

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