Palliative/ELC Certificate Application Form

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Online Application

The Application form below will open an application with the School for Social Work. Please be sure to submit the following materials by online form, mail or email ( resume, personal statement, 2 reference letters.

Field Affiliate Agreement
Personal Information
Employment Information
Optional Information

Smith College seeks students of all racial and ethnic groups. If you wish to identify yourself as a member of a racial or ethnic group, please indicate below. If applicable, you may check more than one box. We invite you to be specific. (Optional information, not required for consideration of application.)

If you are unable to use this form, e-mail us at the Smith College School for Social Work Office of Continuing Education, or call us at (413) 585-7970.

By submitting this form, I confirm my application to the Certificate Program for Palliative and End-of-Life Care.

Note: you will be charged the $40 application fee on the next page.