Request for Mediation Certificate
YOU MUST HAVE SUCCESSFULLY COMPLETED ALL CLASSES LISTED BELOW AND GRADES MUST BE FINAL BEFORE YOUR REQUEST WILL BE PROCESSED.
Instructions:
1. Complete the information requested below by filling in all blank in the table below.
2. Sign and date the request.
3. Select one option below the signature line.
4. Return completed form to the Institute of Applied Economics:
- In person to Chilton Hall, Room 263; or
- By mail to Dr. William McKee, College of Public Affairs and Community Service, 1155 Union Circle #311340, Denton, TX 76203-5017; or
- By fax to 940/565-4663, ATTN: Dr. McKee.
Please print or type responses in space provided.
| Name:_________________________________________________________________________ (This is how your name will appear on the Certificate.) |
|
Student ID:______________________________ (not SSN) |
Daytime Phone:__________________________ |
| Courses and Semester completed for Certificate: | |
|
Courses |
Semester Registered |
|
|
______________________________________ |
|
|
______________________________________ |
______________________________________
______________________________
Signature
Date
(check one)
| _____ | I will pick up my certificate from the department located on the UNT Denton Campus, Chilton Hall, Room 263. Please contact me by phone or e-mail at _______________________________________________________________________ when the certificate is ready. |
| _____ | Please mail the
complete certificate to me at _________________________________________
___________________________________________________________________________ |
PLEASE NOTE: Certificates are prepared and mailed three times per year after the end of each spring, summer, and fall semester. Request forms need to be submitted as soon as possible at the end of the semester in which all courses required for the certificate are completed. Date guidelines for submitting request forms for certificates are:
| Semester all Classes Completed |
Request Form Due* |
Certificate Ready* |
| Spring | June 1st | June 15th |
| Summer | Sept. 1st | Sept. 15th |
| Fall | Jan. 20th | Feb. 5th |
*While we will strive to meet these dates, actual dates may be up to two weeks later than those listed because of other deadlines and workload.
If you have any questions when completing this form, please contact Dr. McKee by phone at (940) 565-3437 or in person in Chilton Hall, Room 263.