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Certificate Application

* indicates required field
 
Students can pay the certificate fee in Genisys by making a credit card or webcheck payment to their student account by clicking on the Tuition and Fees Online Payment tab. Students may also pay in person with cash or check at the Business Office.
 
Please choose which certificate you are applying for:  *
Please choose the concentration of your certificate: 
Term: * Year: *
Note: Students who are denied clearance for their certificate in the term stated on this application must file another application in the subsequent term in which all requirements for the certificate have been met.
Type your name exactly as you wish it to appear on your certificate.
First Name:  *
Middle Name: 
Last Name:  *
Suffix: 
Student ID:  *
Email Address:  *
School:  *
Program: *
Major: *
Advisor: *
 
Important: If more than one certificate concentration is being applied for, please fill out and submit separate applications for each concentration. Candidates must pay a certificate fee for each certificate that they receive.

Certificate Mailing Address: Please keep your address up-to-date in Genisys, including after your graduation. At the time of certificate conferral, Regent uses your most recently updated address (either from Genisys or your certificate application) for your certificate order. If your certificate is returned as undeliverable, additional fees may apply to ship your documents to a forwarding address.
Street: *
Apt. #:
City: *
State: *
State/Country (if not listed above):
Zip Code: *
International Tracking Requested?* Yes  No
*NOTE: Additional fees will apply for International Tracking, ranging from $60 to $130.If you select International Tracking, the Registrar's Office will contact you with information regarding your shipping options and their costs.