Date: 11/19/2018
Page 1 of 2
UNIVERSITY OF GUAM Enrollment Management & Student Success
UNIBETSEDÅT GUAHAN Admissions & Records
APPLICATION FOR CERTIFICATE PROGRAM:
UNDERGRADUATE: HEALTH SERVICES ADMINISTATION LIBRARY SCIENCE WOMEN & GENDER STUDIES
GRADUATE: MICRONESIAN STUDIES TEACHING SAFNR (Track: ___________________)
STATUS: CERTIFICATE ONLY CURRENT STUDENT NEW STUDENT
IMPORTANT NOTICE: ADDITIONAL REQUIREMENTS LISTED ON PAGE 2.
PERSONAL INFORMATION (Please print clearly)
Full Name (Last, First, Middle)
Former Name (Last, First, Middle)
Date of Birth
UOG Stud
ent ID #
Mailing Address
Home Address
Home Phone #
Cell Phone #
Work Phone #
Email Address
Residency Status
(please check one)
Resident
Nonresident
Citizenship &
Ethnicity
Native Language
EDUCATIONAL BACKGROUND
Term Las
t Attended at UOG (if Applicable)
Fall __________
Spring __________
Summer __________
UOG Degree Earned
Graduation Date
Other Colleges/Universities attended (please list)
Institution Dates of Attendance Degree
____________________________________________________________________________________ _______________________________ __________________
____________________________________________________________________________________ _______________________________ __________________
Were you ever suspended, dismissed or asked to withdraw f
rom UOG or any other College/University?
No
Yes (If yes, please complete the following)
Institution Academic Term Action Taken
____________________________________________________________________________________ _______________________________ __________________
____________________________________________________________________________________ _______________________________ __________________
EMERGENCY INFORMATION
Parent, Guardian or Next of Kin
Relationship
Mailing Address
Email address
I certify that the responses I have given above are true and complete. I have not omitted any of the requested information. I understand that any
false information found to be given or held by me herein or in any supporting documents shall be cause for my immediate dismissal.
Signature: Date:
FOR OFFICIAL USE ONLY
Pending Documents: Academic Transcript(s) Sexual Misconduct Training Academic Progress Form
Other:
Pending Clearance: Health Collections RFK Library ROTC Student Housing (Dorm)
Application Complete: Yes No Processed by: Date:
Application fee ($52.00 for certificate-only) _______________ Cashier’s initial: ________________
click to sign
signature
click to edit
Date: 11/19/2018
Page 2 of 2
UNIVERSITY OF GUAM Enrollment Management & Student Success
UNIBETSEDÅT GUAHAN Admissions & Records
ADMISSION REQUIREMENTS
Former students who have not attended the University of Guam for at least one regular semester (Fall or Spring) are required to
submit an Application for Re-entry to the Admissions & Records Office. A cumulative grade point average of 2.00 on a 4.00 scale is
the minimum requirement for satisfactory academic performance. Students who do not satisfy the minimum requirement will be
admitted to the University on probation. Students who are admitted on probation must maintain a grade point average of 2.00 or
better during the first semester/term of re-enrollment to be eligible for continued enrollment.
OFFICIAL TRANSCRIPTS (For Certificate-Only Students)
Official transcripts from all colleges/universities attended during the student’s non-attendance at the University of Guam are
required and must be submitted directly to the Admissions & Records Office from the issuing institution prior to application review.
All official transcripts must be submitted to the Admissions & Records Office by the end of the first semester/term of entry. A
student may not register for another semester/term until official transcripts have been submitted. Payment of a nonrefundable
application fee of $52.00 is required for Certificate-Only students.
HEALTH REQUIREMENTS (For Certificate-Only Students)
All students are required to supply the Student Health Services Office with evidence of having been vaccinated against measles,
mumps and rubella (MMR) and the results of a tuberculin skin test taken no earlier than six months of the date of application. Please
make sure all health information is up-to-date at the Student Health Services Office. Download form at
https://www.uog.edu/_resources/files/admissions/student_health_clearance_form_revised_11-16.pdf
SEXUAL MISCONDUCT TRAINING (ONLINE)
All students must complete the annual online Sexual Misconduct Training. You will need your UOG Student ID#. You can access
the training at: Student Sexual Misconduct Training.
For information on how to obtain your Student ID#, call (671) 735-2204/06/10/11 or email: admitme@triton.uog.edu
For assistance with UOG Moodle, call (671) 735-2620/21 or email moodlehelp@triton.uog.edu
For more information about UOG’s updated Sexual Misconduct Policy, visit www.uog.edu/helpline
To download the updated Sexual Misconduct Policy, visit http://goo.gl/LMGP9
REMINDER
PROGRAM REQUIREMENTS (CATALOG IN FORCE) FOR GRADUATION
Certificate Programs are designed to be earned in a short period of time. Therefore, only the current Undergraduate Catalog or
Graduate Bulletin requirements shall apply when the student applies for graduation at the completion of their certificate. If a
certificate program has been discontinued, the teach-out policy shall apply.