Certificate Declaration Request

To enroll in a certificate and be eligible to receive the certificate degree at graduation, students must declare their intention to complete the certificate by filing the certificate declaration form.

Fields marked with * are required.

NOTE: Certificates are open to degree students only. They are awarded simultaneously with the degree.
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 Director of Graduate Studies/Program Director. The program administrator in your degree 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

Program:

EMPLID

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

Student Signature

Please type your full name as an electronic signature.

Signature