The University of Memphis
GRADUATE CERTIFICATE PROGRAM CANDIDACY

Intent to Graduate Card submitted?   If no, "click here" to submit electronically.

Full Legal Name:   Banner ID:
Current Address:
E-mail Address:
Home Phone:   Work Phone:
Degree:
Major:


FOR OFFICE
USE ONLY
_____:Intent
_____: GPA

CERTIFIED:

___________

LIST COURSES REQUIRED IN CERTIFICATE PROGRAM

Dept. Course No. Course Title Sem. Hrs. Grade Year

TOTAL NUMBER OF HOURS REQUIRED IN CERTIFICATE PROGRAM: 

Certificate Program Approvals:
Major Advisor: ___________________________________________________  
Date:_____________
 
Graduate Coordinator: ____________________________________________		  
Date:_____________
 
Department Chair:___________________________________________________		  
Date:_____________
 
College Director of Graduate Studies:_____________________________________		  
Date:_____________

The University of Memphis offers equal educational opportunity to all persons without regard to race, religion, sex, creed, color, national origin or disability. The university does not discriminate on these bases in recruitment and admission of students or in the operation of any of its programs and activities, as specified by federal laws and regulations. The designated coordinators for University compliance with section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 are the Vice President for Student Affairs and the Equal Employment Compliance Officer. Information in this document will be provided in alternate format upon request. The University of Memphis is an Equal Opportunity/ Affirmative Action University. It is committed to education of a non-racially identifiable student body.

Revised: 8/1/07