Office of the Registrar APPLICATION FOR CERTIFICATE/ADVANCED CERTIFICATE Daemen College
PLEASE TYPE OR NEATLY PRINT ALL INFORMATION.
Applications will not be processed without the student’s signature and date of signature
indicated. Applications may be faxed (716-839-8343), mailed (Registrar’s Office, Daemen College, 4380 Main St, Amherst, NY 14226), or delivered to the
Registrar’s Office (Duns Scotus #120).
CERTIFICATE/ADVANCED CERTIFICATE PROGRAM: _______________________________________________________
Campus Location (Check One): □ Main Campus □ Brooklyn Campus □ Online
I WILL COMPLETE ALL REQUIREMENTS FOR THE CERTIFICATE PROGRAM AND ALL DOCUMENTATION WILL BE ON FILE AT
THE CONCLUSION OF (check one AND indicate year):
□ January ______ For Students Completing requirements from October 1
st
through January 15
th
(Year)
□ May ______ For Students Completing requirements from January 16
th
through May 31
st
(Year)
□ September ______ For Students Completing requirements from June 1
st
through September 30th
(Year)
MY NAME AS IT SHOULD APPEAR ON THE CERTIFICATE: Print one letter in each space. Leave a space blank if a space is required. All letters
will be capitalized unless otherwise indicated. If you wish to have your name listed differently than that which appears on your academic record, you must
append a copy of the legal document which verifies the name change, i.e., marriage certificate, divorce decree, legal change of name, etc. If your name is
legally to be changed after
this form is filed, at your request, your certificate will not be printed until the legal documentation is submitted to the Office of the
Registrar.
_____/_____/_____/_____/_____/_____/__ _____/_____/_____/ - _____/_____/ - _____/_____/_____/_____/
(STUDENT ID NUMBER) SOCIAL SECURITY # (Only if Student ID Number not given)
_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____
(FIRST NAME)
_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____
(MIDDLE OR MAIDEN NAME)
_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____/_____
(LAST NAME)
ADDRESS TO WHICH YOUR CERTIFICATE SHOULD BE MAILED:
(Diplomas will be ready to be picked up in Registrar’s Office 6-8 weeks after conferral.
We will hold them in office for a two week period to be picked up after that they will be mailed to the address listed below. Please check your Daemen E-mail for notification with
pick up details.)
________________________________________________________________________________________________________________________________
(Street Address) (City) (State) (Zip)
PHONE NUMBER ________________________________________ All communication from Registrar’s Office will be sent to your Daemen E-mail only
POLICIES RELATIVE TO COMPLETION OF CERTIFICATE PROGRAMS:
1. Students satisfying all certificate program requirements must complete and submit the Application for Certificate form to the Office of the Registrar. Applications must be
filed in the semester prior to the final term of studies for completion of certificate requirements. Students who do not file an application will not be reviewed to determine
status on completion of requirements, thereby prohibiting reflection of certificate completion on the academic record and preparation/release of the certificate.
2. Students must satisfy all certificate program requirements. Consult the college catalog or the Program Plan on the Registrar’s web page for a complete listing of requirements.
3. Official documentation for all completed coursework must be received by the Registrar prior to verification of certificate completion. Documentation for transfer credit or
cross registration credit is an OFFICIAL TRANSCRIPT(S) from the institution(s) granting credit. Faxed transcripts are NOT
acceptable. Hand-delivered official
transcripts are acceptable provided that they are marked as such and arrive in a sealed envelope with the seal unbroken. Documentation for Daemen College coursework
(including grade changes and Incomplete grade changes) is the completed grade change form bearing the Instructor’s signature and the student’s final grade.
4. GRADE CHANGES AND CHANGES IN INCOMPLETE GRADES:
It is STRONGLY RECOMMENDED that students with grade changes contact their instructor
to assure that the instructors has submitted the appropriate grade change form to the Registrar’s office.
5. Final credit evaluations are completed for all applicants at some point during the final term of study and the student will be notified of the status for certificate completion via
email Daemen email account. The Registrar’s Office is the only College department with the authority to verify completion of certificate program requirements. As
this review will take place after
the drop/add period, it is strongly recommended that applicants run their evaluation in Self-Service; should they see any problems with
their status for completion, they should contact the Registrar’s office immediately.
6. Transcripts or any document which is generally accepted in lieu of a transcript (including the certificate) will not be released for any student whose financial obligation to the
College has not been satisfied.
I have read this form and understand College policies as stated in this document. (THIS FORM WILL NOT BE PROCESSED WITHOUT THE
STUDENT’S SIGNATURE).
_____________________________________________________________ _______________________
STUDENT’S SIGNATURE DATE
APP_CERTIFICATE 02/2019
Registrar’s Office Use only:
Moved to:
□ FA _____ Year Initials: _______ Date:______
□ SP _____ Year Initials: _______ Date:______
□ SU _____ Year Initials: _______ Date:______
