Office
of Records and Registration
Winthrop University
126 Tillman Hall
Rock Hill, SC 29733
Phone: 803/323-2194
FAX: 803/323-4600
APPLICATION FOR COMPLETION OF GRADUATE CERTIFICATE
Please
print clearly or type all information requested. Certificate orders are based on the information provided on this form
.
*
Application fee
- A $25 application fee will be charged to your student account. Please do not enclose payment when submitting this
application.
Completion Term
:
May August
December
Student Number
Year Year Year
Name
on
Winthrop
record:
Last First Middle Suffix
Address:
Street City State ZIP
Telephone:
Daytime Evening E-mail Address
Name
to
appear
on
certificate:
First Middle Last Suffix
Area of Certification Adviser
Student Signature Date
1/15
RECORDS AND REGISTRATION USE ONLY
__________ __________ __________ __________
SGASTDN SHADEGR SHADIPL SPAIDEN
__________ __________ __________
POS/SHANCRS H REQ’D FINAL GPA
Cours
e Number Credit Hours Grade
__________ __________ __________ __________
__________ __________ __________ __________
__________ __________ __________ __________
__________ __________ __________ __________
__________ __________ __________ __________
