Advanced Certificate Enrollment Form

Advanced Certificate Enrollment Form
Name*

First NameLast Name
BTECH ID
Birth Date*

MonthDayYear
Email*
example@example.com
Program Name*
Department Email:
The completion of prerequisite courses may be required prior to your enrollment into your selected program. If prerequisite courses are needed, the department will deny your request and list any required prerequisite courses in the denial comments.
How are you meeting admissions?*

Certificate of Completion from BTECH or another related, equivalent programRelated associates degree or higher from a nationally/regionally accredited institutionRelated Industry Experience
Certificate of Completion Name:*
Institution Completed at:*

BTECHOther Institution
Name of Degree Completed:*
Institution Completed at: *
Upload Official Transcripts if completed at Other Institution (If official transcripts are being mailed/emailed directly to Student Services, please indicate in the comments)

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Upload Official Transcripts: (If official transcripts are being mailed/emailed directly to Student Services, please indicate in the comments)

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Comments:
Employer Name: *
Supervisor Name: *
Employer Phone #: *
Please enter a valid phone number.Format: (000) 000-0000.
Length of Employment: *
8 months, 1 year, etc.
Job Position(s): *
Responsibilities (please attach a job description or letter verifying job duties from your supervisor.)

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Recommended Prerequisite Course(s):
If you are required to submit an official transcript or documentation for related industry experience, Student Services will not approve your request until it is received.
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