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Office Use Only: Approved: YES NO Office of Academic Affairs Representative, Printed Office of Academic Affairs, Signature Date Plan Code: Cert. Plan Code: Graduate Certificate for Degree-Seeking Students Current degree-seeking students may use this form to elect a graduate certificate. Instructions for this form: 1. Complete student information 2. Complete certificate election information 3. Obtain approvals prior to submission (electronic signature accepted) Name: Student ID: Campus: Program: Department: Major: Elected Certificate: If electing the Global Health Certificate, please state your interest(s) in electing this certificate: Student, Printed Student, Signature Date Faculty Advisor, Printed Faculty Advisor, Signature Date Certificate Faculty Advisor, Printed Certificate Faculty Advisor, Signature Date (Required for Global Health, Maternal & Child Health, and Physical Activity & Health Certificates) (Required for Global Health, Maternal & Child Health, and Physical Activity & Health Certificates) Submit documents with signatures to: Office of Academic Affairs and Student Services ([email protected])
