Graduate Certificate Completion Form - Kansas

GRADUATE CERTIFICATE COMPLETION FORM
Submit original to:
Graduate School
103 Fairchild Hall
List courses completed for certificate program
Total KSU Credits
Is this certificate to be prepared by the Graduate School?
Note: Credits that were earned more than six years prior to the semester in which the certificate is
approved cannot be accepted.
I hereby verify to the best of my knowledge that this student has or will have met the requirements of
completion for this certificate program by the end of this semester.
________________________________________________
Signature of certificate program coordinator
________________________________________________
Name of certificate program coordinator (Please Print)
________________________________________________
Date
Student Name:
Student Number:
K-State eID:
Certificate Program:
Semester of completion:
Dept
Code
Course
Number Course Name
Credits
Semester
Taken
Date Needed
For GS Use Only:
______ ED
______ CC
______ C - DW
______ STD
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