Only fill out this form if you have absolutely completed all classes required for your certificate and have officially passed all your courses. Requests for certificates for programs that have not been completed (included grade release) will not be processed. If you have completed your program and have received your grades, please complete this online form in order to receive your certificate in the mail. This information is used to create your official University of Chicago academic record. Completing this survey ensures that your certificate is either linked to a record you may already have in the University’s database (if you have a previous connection to the University) or allows us to create a new record that distinguishes you from others who may share your name. The non-required information assists in this process.

* 1. Please tell us your formal name:

* 2. How would you like your name to appear on the certificate?