Academic Certificate Course Verification
Planned Program – Additional Courses (con't)
Courses Term Completed
APPLICATION FOR ACADEMIC CERTIFICATE
Please read the information below before completing the
Application for Academic Certificate Application
Academic Certificate Fee(s) – Please pay the $10.00 fee at the Brusar’s Office (Lassen Hall) before
submitting the form to the Office of Graduate Studies (River Front Center, Room 215). Please read the
information below before completing the academic certificate application.
Due Dates: Return this form to the Office of Graduate Studies by the date noted below:
October 1 (for Fall Certificate Completion) / February 1 (for Spring/Summer Certificate Completion
Changes to Academic Certificate Application - Make a copy of this application for your records. If you
have changes, please visit the Office of Graduate Studies, River Front Center, Room 215.
Approval of Academic Certificate Course Verification – If you do not have an approved Academic
Certificate of Completion Course Verification form on file with the Office of Graduate Studies, your Application
for Academic Certificate application will be returned to you.
Certificate Mailing Address- You will receive your certificate approximately six (6) months after
Completion of Certificate Program.
Note: If your address is different than the one listed on this form, you must file a "Data Change Form" with the
Office of Graduate Studies or update your records on your My Sac State account.
Approval Signature – Obtain the appropriate signature of your departmental faculty advisor.