Certificate Declaration Request (Freestanding Programs)

Fields marked with * are required.

NOTE: Certificates are open to degree students only. They are awarded simultaneously with the degree.

Complete this form if you are NOT currently enrolled in a Laney Graduate School degree program.

If you have questions about whether you are eligible to declare and earn a certificate, please contact Tamika Hairston at tamika.hairston@emory.edu.

This form will initiate a certificate declaration agreement that must be completed by you and approved by the Certificate Director and by your primary advisor in your degree program. The program administrator in your certificate program will receive a copy of your request. The date of the Certificate Director's signature will determine the effective term for this change in OPUS.

More information about this process can be found on our website.

Student Information

Name:

School:

EMPLID:

Emory Email:

Certificate Declaration

Select the Certificate Program you would like to declare:

I agree to inform, in writing, both the Laney Graduate School and the appropriate Certificate Program Director if I wish to be removed from the certificate program.

I agree

Attach Your Signed Certificate Declaration Form:

Student Signature

Please type your full name as an electronic signature.

Signature