College of Letters, Arts, and Sciences
University of Colorado Colorado Springs
Department of Geography and Environmental Studies
Request for Award of Certificate
Undergraduate Certificate in Geographic Information Science
Name: _________________________________
Student ID: _________________________
E-mail: _________________________________
Phone Number: _____________________
Mailing address (the certificate will be sent to this address): _______________________________
________________________________________________________________________________
I, ____________________________________, have fulfilled all the required courses as indicated below.
(Print name as it will appear on certificate)
Required Courses
Course #
Course Name
Semester and year
completed
Grade
Validated
Elective Set One
Course #
Course Name
Semester and year
completed
Grade
Validated
Elective Set Two
Course #
Course Name
Semester and year
completed
Grade
Validated
Date of completion of requirements: __________________________
I hereby request that my file be reviewed for completion and that I be awarded my certificate.
_____________________________________
Student
Date
_____________________________________
Certificate Director
Date
_____________________________________
Department Chair
Date
In effect after August 24, 2015