| If the time since graduation is not covered by your
previous answers to college and university dates attended, indicate below how you have
been employed prior to attending FIU. Occupation Name and Address of Employer Supervisor's Name From To __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ Please list three references that may be contacted concerning your professional abilities: __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________
__________________________________________________________________________________________________________ Academic Department Use Only The student's academic credentials have been reviewed and the student is hereby accepted into the Certificate Program. Academic Department's Authorized Signature: _________________________________________ Date: ___________________ The student's academic credentials have been reviewed and the student is not accepted into the Certificate Program. Academic Department's Authorized Signature: _________________________________________ Date: ___________________ Note: Please return this form to the Office
of the Registrar and notify the student of your decision.
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