LSU | Graduate School
Page 1 of 2
Updated 3/2019
Online Graduate Certificate Application for Degree
Email submission to gradsvcs@lsu.edu.
Student Information:
Degree Only Registration: Yes No
Name:
(See Catalog for requirements)
LSU Student ID:
Degrees Held (include institution and year):
Degree Conferral Date:
Major Field:
Anticipated Term of Completion:
Department:
Degree Information:
Name of Certificate:
College:
Name as it Shoul
d Appear on Diploma:
First Name:
Middle Name:
Last name:
Hometown:
Home State:
Parish/County:
Country:
By signing below, I acknowledge that I understand that the name provided above will appear on my
diploma.
Signature:
Date:
Phone:
LSU Email:
Mailing Information:
Mailing Address: (street or P.O. Box)
City State Zip Code Country
Diploma Distribution:
I wi
ll attend the ceremony.
I wi
ll not attend the ceremony.
Graduate School
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signature
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LSU | Graduate School
Page 2 of 2
Updated 3/2019
Online Graduate Certificate Degree Audit
Email submission to gradsvcs@lsu.edu.
Phone:
LSU Email:
Student Information:
LSU
Student ID:
Name:
Home Department:
Program Certificate:
Coursework Information:
List all relevant LSU courses and hours required toward this certificate.
(Ex: EDCI 7055 (3), ECI 7930 (6)
Cours
es Completed at LSU:
Courses Transferred or Petitioned (list institution and date taken) Hours Completed:
Courses Remaining: Hours Remaining:
Signatures:
Student: Date:
Graduate Program Advisor: Date:
Dean of the Graduate School: Date:
REG:
For Office Use Only:
GPA:
TIME:
CW:
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signature
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