Conferral Form for Certificate Students

This form will be used by the Registrar's Office and Office of Graduate and Extended Programs. If your computer uses autofill, please double check all answers, especially your "Name on Certificate" as that is exactly how we will order it.

ID#

Your 7 digit ASC ID#

First Name*

Your legal first name

Middle Name

Last Name*

Your legal last name

Name on Certificate*

What name would you like to appear on your certificate. Examples: First Middle Last, First M. Last, First Last

Accent Marks

Does your name contain accent marks that you were not able to type? If so, please describe. i.e. accent over e in first name á é ó accent/apostophe ñ tilde ö umlaut â ô caret à è ò accent grave

Advisor Name*

Enter your advisor's first and last name.

Advisor Email*

Your advisor will receive a notification that you have submitted the graduation application.

Expected completion Date*

Select

Certificate Expected*

Post-Baccalaureate Pre-Allied Health Certificate

Post-Baccalaureate Pre-Medical Certificate

Certificate in Advocacy and Public Engagement

Certificate in Technology Leadership and Management

Certificate in Data Visualization

Certificate in Evaluation and Assessment Methods

Certificate in Writing and Digital Communication

Mailing Address*

Please provide your current mailing address, including city, state and zip, in case we need to contact you regarding your certificate.

Phone #*

Your current phone number in case we need to contact you regarding your certificate.

ASC Email Address*

Enter your Agnes Scott email address

Email Address*

Non-ASC email address in case we need to contact you regarding your certificate.

Acknowledgement*

Students completing a certificate will be charged a $50 completion fee. The completion fee is a one-time, non-refundable fee that will be added to your account after you submit this form. This fee is required of all students who expect to complete a certificate and must be paid before you receive your certificate. Check this box to confirm that you have read this statement.

Office of the Registrar

Buttrick Hall, room 101B 404-471-6137 registrar@agnesscott.edu

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