UO ID _______________ Last Name _____________________ First Name ______________________
UO Email _________________________ Major _______________________________
Degree Level (check one): O Masters O Doctoral Certificate Program:_____________________
_____
Signature: _____________________________________________________ Date: _____________________
University of Oregon Graduate School • (541) 346-5129 • gradsch@uoregon.edu • Susan Campbell Hall
Declaration of Graduate Certificate
This form must be completed by all students pursuing graduate certificates along with their graduate degree programs. It must
be
submitted to the Graduate School within one term after admission to the certificate program. (Note: This does not apply to
College of Education certificates.) This form must be filed in the Graduate School no later than week 5 of any term in which
you want to make a change. Forms submitted after Week 5 of the term will automatically be considered for the
next academic term.
CERTIFICATE PROGRAM APPROVAL
By signing below, the department/program offering the certificate confirms that (1) this student has been accepted to the
above‐named certificate
program; (2) the student has met with the department/program and has a documented, approved
course of study that establishes
the requirements that must be completed for the above‐named certificate program.
Printed Name: ________________________________________________________ Date:________________________
Director or Representative of Certificate Program
Signature: ________________________________________________________________________________________
IMPOR
TANT
INFORMATION ABOUT PURSUING GRADUATE CERTIFICATES
Minimum
Graduate
School Requirements: Students pursuing graduate certificates are responsible for meeting
minimum Graduate
School requirements as outlined on the Graduate School website: http://
gradschool.uoregon.edu/policies‐procedures/graduate‐
certificates
Graduating with the Certificate:
No later than Friday of Week 2 in the term of graduation (for the graduate certificate, the graduate degree, or both the
degree and the
certificate), the student must apply for graduation online.
No later than Friday of Week 8 in the term of graduation for the certificate, the department/program must submit an
online “Statement of
Completion for Graduate Certificate” as well as a hard copy of the departmental program plan
indicating the courses (titles, term taken, number of credits, and grade for each) being used to fulfill the requirements of
the certificate. (Note: Effective Winter 2012, the
departmental program plan will no longer be required.)
GRADUATE SCHOOL DECISION Approved Denied
Effective Term: _________
Signature: _____________________________________________________ Date: __________________
