Fillable Academic Certificate Course Verification (California State University, Sacramento)

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Academic Certificate Course Verification (California State University, Sacramento)

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The Academic Certificate Course Verification (California State University, Sacramento) form is 2 pages long and contains:

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  • 6 check-boxes
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Country of origin: US
File type: PDF

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Previous Degrees:
Name of Certificate:
Date:
Is applicant matriculated at Sacramento State?
o o
Will applicant enroll through Open University?
o o
Does applicant meet pre-requisites for Certificate?
o o
A
Total Units Required for Certificate:
B
C
D
Department of:
I hereby certify that all requirements have been completed and that a Certificate of Academic Achievement shall be
awarded to:
Units Completed: Approved Date:
Graduate Studies Dean's Signature: Date:
White Copy - Grad Studies Yellow Copy - Department Pink Copy - Student
2019 Sept
Print Name of Chair or Program Coordinator
Academic Certificate Course Verification
Office of Graduate Studies
Last
First
MI
Student ID #
Email
Telephone (include area code)
No
Yes
Zip
ST
Address
Student Signature
No
Student Name:
College in which certificate will be granted:
Yes
No
Yes
Grade
Term Completed
City
Deadline: October 1 (for Fall Completion) / February 1 (for Spring/Summer Completion)
Signature of Dept. Chair / Program Coordinator
Expected Completion Date:
Required Courses
Elective Courses
Completed
Grade
Academic Certificate Course Verification
Planned Program – Additional Courses (con't)
Courses Term Completed
Grade
APPLICATION FOR ACADEMIC CERTIFICATE
GENERAL INFORMATION
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.
2019 Sept
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Academic Certificate Course Verification (California State University, Sacramento)

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Completed 18 August 2020

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