DEGREE CERTIFICATION REQUEST

TO:		Registrar
	
		_________________________
		Name of Institution		

		_________________________
		Address					

		_________________________
		City/State/Zip Code

DATE:	_________________

	The University System of Georgia Board of Regents requires the verification of highest academic degrees held by the faculty.  A contract for the employment of a prospective faculty member is, therefore, contingent upon official certification of the degree.  Your cooperation in the execution of this certification form will be sincerely appreciated.

	This is to certify that                                         (_____________________)
				       (Name in full)               Social-Security Number

has satisfactorily complied with all of the degree requirements, and was awarded the 

_____________________________ degree in _____________________________ by
 (Record highest academic degree)                             (Area of specialization)

by this institution on                                                        .
       			                   (Date)

							___________________________________
							Signature

							___________________________________
							Title (Registrar or appropriate officer)
(SEAL OF INSTITUTION)
_____/_____/_____				 
Date
  Please return to: