CERTIFICATE APPLICATION

1. Certificate Application (this form) must be filed with Admissions & Records by the following deadline.
2. Prior to Submission of the Certificate Application:
3. Please note that the college assigns all students an email address. ALL notifications and announcements regarding graduation evaluation, acceptance, denial, etc. will be sent to this college assigned email address. It is the student’s responsibility to check this email account or forward it to a personal email address.

Student Information

Please choose Graduation Term*field type radio button
Please choose Graduation TermSpringSummer
Please choose Graduation Year*field type number
First Name*field type single line
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Last Name*field type single line
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Student ID*field type single line
Must be 7 digits. Example 0123456.
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Phone Numberfield type single line
Format: 555-555-5555
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College Email*field type single line
example@mycod.us
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Type your name EXACTLY as you wish it to appear on your certificate.*field type single line
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Certificate Program*field type drop-down
Certificate Previously Offeredfield type single line
Type Certificate previously offered. You must have catalog rights for this Certificate.
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Certificate Mailing Address:*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
During the Commencement Ceremony, we will take time to celebrate any International Countries or Tribal Nations our students come from. If you wish for us to recognize that country or tribe, please list it here.
Country to Recognizefield type single line
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To apply coursework from another institution to this Certificate:

List colleges or universities attended with coursework to be considered for this certificate:

Are you currently enrolled in another institution required for this certificate?*field type drop-down
Please upload your unofficial transcript or schedule using the Document(s) Upload Portal.
College/Institution 1.field type single line
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College/Institution 2field type single line
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College/Institution 3field type single line
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College/Institution 4field type single line
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Comments

Additional Commentsfield type multi line

Student Declaration

I hereby certify, under penalty of perjury, that the information provided in this form is complete and accurate and that I have read and understand the information in both pages of this form. I understand it is my responsibility to monitor my college email account for results of this request
Please select.*field type radio button
I give permission for my name, COD email, mailing address, major and graduation honors to be printed in the Commencement Program, media, and/or released to the graduation photographer.
Please select.YesNo
Student Name*field type single line
This constitutes as e-signature.
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Date*field type date