Fillable Application to Declare Certicate Candidacy (New York University)

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Application to Declare Certicate Candidacy (New York University)

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Ofce of Noncredit Student Services
7 East 12th Street, Room 923
New York, NY 10003
P: 212-998-7150
F: 212-995-3060
sps.nyu.edu/professional-pathways
Application to Declare Certificate Candidacy
To earn a certificate, students must complete this Application to Declare Certificate Candidacy form at the beginning
of their course of study. If you have not registered for your classes, we encourage you to register with us online or
by phone at 212-998-7150. Forms can be submitted via email at sps.certificate@nyu.edu; or by fax at 212-995-3060.
Name D.O.B.:
Legal Sex (optional):
Male
Female
Gender Identity (optional):
Man Identified
Woman Identified
Gender Non-Conforming
Address:
City: State: Zip/Postal code:
Phone: Email:
Title of Certificate Program:
(Students may not participate in multiple programs concurrently)
Signature:
Date:
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Application to Declare Certicate Candidacy (New York University)

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Completed 14 January 2021

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