To be eligible for Federal student aid, a student with a prior bachelor’s degree must be enrolled in an academic program that leads to
admission into a degree seeking or graduate program.
Student Information
Name:___________________________________________________________________________________________________________________
Last four digits of Social Security Number: |____|____|____|____| Student ID: ________________________________________________
Student Academic Certification
I HAVE NOT completed a Bachelor’s Degree (Proceed to Student Signature section)
I HAVE completed a Bachelor’s Degree (Complete all sections of this form)
Prior Degree Confirmation: List all degrees you have completed, the school from which you received the degree, and the date you
graduated. Attach additional pages if necessary.
Degree Received (ex. BS, BA, MS) Name of School Date Degree Received
Name of program you are seeking to complete:_________________________________________________________________
Please indicate your reason for seeking additional educational training beyond a bachelor’s degree (check all that apply):
Pursuing a Second Bachelor’s Degree Teacher Certification Program
Enrolling in prerequisite courses needed for admission into a Graduate Program. (You must supply a letter or printed
material from the Graduate school you will be attending, outlining all required prerequisite courses. You must also
supply our office with a copy of your scheduled classes at Pitt-Johnstown.)
Submit this form to your Advisor to complete the section below.
Second Bachelor’s Degree Teacher Certification
# of credits from 1st degree applied to 2nd degree # of credits needed to complete Teacher Certification
# of credits remaining to receive 2nd degree Anticipated Graduation Date
Anticipated Graduation Date
Advisor Certification (To be completed by your advisor): I certify that this student is taking prerequisite courses to gain
eligibility into a graduate program, pursuing a second degree, or completing a teacher certification.
Advisor Name (Printed): ____________________________ Advisor Signature: ________________________________________
Phone:______________________________Department: _____________________________________ Date:_________________
Student Signature__________________________________________________________________Date________________________________
