Saint Louis University Graduate Education
Revised 8/10
Petition to Pursue a Certificate within a Graduate Program
INSTRUCTION: This form is only to be used by a Classified Graduate School student at Saint Louis University desiring to
pursue a certificate concurrent with (parallel to) an advanced degree. After completing the first section of the form, the student
must route the petition to the major field for clearance and evaluation, then to the certificate director for assessment of adequate
preparation, and finally to the Dean/DirectorDesignee of the College/School/Center.
Please print:__________________________________________________________ _______________________
(Last Name) (First Name) (Middle Initial) (Banner ID)
Local Address:_________________________________________________________________________________
(Street, Apt) (City) (State) (Zip Code)
E-mail Address:______________________________________ Local Phone No.____________________________
I have been unconditionally admitted to seek Master’s Ph.D. degree with a major in:_____________________
_______________________________________ I desire to add to my current degree-program pursuit of the
“parallel” certificate checked below.
Certificate in Empirical Research Methods Certificate in Rhetorical Studies in
in Descriptive Ethics Writing Pedagogy
Certificate in Renaissance Studies Certificate in Medieval Studies
Certificate in Women’s Studies
Date:________________________ Signed:_________________________________________________________
Recommendation of the Major Field:
(Note: The student and the major field must understand that, although some completed, advanced, academic work
will partially fulfill requirements for both certificate and degree, and some elective credits within the degree
program may be assigned to the certificate, full completion of both sets of requirements may total in credit hours an
amount greater than that required to earn the degree alone.)
I recommend approval denial of this petition.
Signed:________________________________________________________ ____________________________
(Major-Field Chairperson/Program Director) (Date)
Comments, if any:______________________________________________________________________________
Recommendation of the Certificate Director:
I recommend approval denial of this petition.
Signed:________________________________________________________ ____________________________
(Date)
Prerequisite deficiencies, if any:___________________________________________________________________
Petition is approved denied by Dean/Director/Designee on this date:__________________________________
Remarks/Conditions:____________________________________________________________________________
________________________________________________________________________________________________________
Signed:__________________________________________________ Title:_______________________________
Copies sent to Student Major Field Certificate Director Registrar on _____________________
(Date)
