Certificate in Information Technology

Department of Computer Science & Information Systems

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Application

Print a copy of this form.  Complete the top portion and send to the CSIS Department.

Name (print) ___________________________________________________ 

Address ________________________________________  SSN ___________________________

              ________________________________________  Telephone _______________________

email ___________________________________________  Fax ____________________________

 Major Program of Study ________________________  Department _________________________

Advisor _____________________________________  Class Standing _______________________

Overall GPA _________________________________

Office Use Only

Date Accepted _____________                    Program Coordinator _____________________________

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Course                                                                                    Required  [ ] CSIS 2300 Principles of Computing [ ] Experiential Elective Choose any three [ ] IT 3300 Web Technologies  [ ] IT 3500 Database Technologies                                 [ ] IT 3700 Information Technology Management  [ ] IT 4525 E-Commerce Total: 15 semester hours

Grade _____ _____ _____ _____ _____ _____

Date Completed _________________        Date Certificate Issued __________________   

June 20, 2001