Graduate Certificate Departmental Approval Form - USF College of

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					Graduate Certificate Departmental Approval Form
Fill out the following information and submit this form to the Office of Graduate Certificates, University of South Florida,
4202 E. Fowler Ave., SVC1072, Tampa, FL 33620-9951. If you have any questions, contact the Graduate Certificate
Office at (813) 974-2442, or by e-mail at: gradcerts@admin.usf.edu.
Please note: If applying for more than one Graduate Certificate, use a separate form for each.

Student Name                                                                             USF- ID Number

Mailing Address                                                                          Daytime Phone

                                                                                         Evening Phone

         E-mail                                                                          Gender (optional)            Race (optional)


  Select the name of the Graduate Certificate you wish to apply to from the drop-down box. See pages 2-4 for Programs, Codes and Contacts.
  LEGEND (for drop-down list): *Partially Online; ** Fully Online; ***Fully Online via APEX

  Graduate Certificate program           XXX - Other

  Semester applying for             Spring                           Year                          Home Campus
                                                                                                                      Lakeland



AcAdemic informAtion

Bachelor’s degree:
                                  Institution                                            Major                                             Year awarded


                                  Minor (if applicable)                                  GPA                                            Upper level GPA

Master’s Degree:
                                  Institution                                            Major                                             Year awarded

Are you currently enrolled in a Master’s or Doctoral degree program?                               Yes           No
If yes, which university and program?


                                  Institution                                            Program                      Year expected to finish

Have you taken the GRE?                   Yes             No                 If yes, indicate score: Verbal           Quantitative

How did you hear about Graduate Certificates?

Will you be taking courses online only?                        Yes          No

AttAchments:
Please attach a statement of purpose, 250-words or less, explaining your interest in obtaining the graduate certificate indicated,
a current resume or curriculum vitae, and official transcripts. If you are having your transcripts mailed directly from another
institution please have them sent to the Office of Graduate Certificates, Room SVC1072. Also, the department to which you are
applying may have additional requirements. Please review the graduate certificate information sheet at:
www.outreach.usf.edu/gradcerts and discuss your interest in the certificate with the certificate director before submitting
the application.


X Student Signature (signature required for processing)                                                                 Date



 DEPARTMENT USE ONLY (Note to Departments: Please return form to: Office of Graduate Certificates, SVC1072

           Accepted                Denied admission into the Graduate Certificate selected above.

 Signed:                                                                                  Date:
           (Must be signed by Graduate Certificate Director)

 Signed:                                                                                  Date:
           (Office of Graduate Certificates)
                                                                                                                                                          1
Graduate Certificate Program Codes & Contacts

 This list is subject to modification. Last update: 9/15/08                     *Partially on-line curriculum **Fully on-line curriculum ***APEX

 Code Name of Certificate                                     Contact               Telephone           E-mail                              Location
 XAS     Addiction & Substance Abuse                          Charlotte Dixon       (813) 974-0973      dixon@cas.usf.edu                    SOC107
 XAF     Africana Studies*                                    Deborah Plant         (813) 974-4220      plant@.cas.usf.edu                   FAO270
 XAN     Aging & Neuroscience                                 Paul Sanberg          (813) 974-3154      psanberg@health.usf.edu              MDC78
                                                              Nagwa Dajani          (813) 974-5724      ndajani@health.usf.edu               MDC78
 XBH     Behavioral Health Counseling                         Charlotte Dixon       (813) 974-0973      dixon@cas.usf.edu                    SOC107
                                                              Gary DuDell           (813) 974-1257      gdudell@cas.usf.edu                  SOC107
 XBC     Biochemistry & Molecular Biology                     Michael Barber        (813) 974-9702      mbarber@health.usf.edu               MDC07
 XBI     Bioinformatics                                       Michael Barber        (813) 974-9702      mbarber@health.usf.edu               MDC07
 XBS     Biostatistics                                        Getachew Dagne        (813) 974-6680      gdagne@health.usf.edu                MDC56
 XBT     Biotechnology                                        Michael Barber         (813) 974-9702     mbarber@health.usf.edu               MDC07
 XCR     Cardiovascular Engineering                           Michael VanAuker       (813) 974-3186     vanauker@eng.usf.edu                 ENB118
 XCC     Career Counseling*                                   Debra Osborn          (813) 974-9932      osborn@coedu.usf.edu                 EDU380
 XCH     Children’s Mental Health**                           Carol MacKinnon       (813) 974-2075      cmackinnon@fmhi.usf.edu              MHC2333
 XCI     Clinical Investigation**                             Phil Marty            (813) 974-8065      pmarty@health.usf.edu                MDC61
 XCT     College Teaching*                                    Jim Eison             (813) 974-4697      jeison@coedu.usf.edu                 EDU162
 XCD     Community Design and Development (on hiatus) Trent Green                   (813) 974-6020      green@arch.usf.edu                   HMS301
 XCO     Community Development                                Robin Jones           (813) 974-8452      jones@cas.usf.edu                    BEH201
 XCL     Comparative Literary Studies                         Susan Mooney          (813) 974-9504      smooney@cas.usf.edu                  CPR107
 XCW     Creative Writing                                     Rita Ciresi           (813) 974-9570      rciresi@cas.usf.edu                  CPR107
 XCA     Criminal Justice Administration*                     Max Bromley           (813) 974-7281      mbromley@cas.usf.edu                 SOC107
 XCS     Cuban Studies                                        Carlos Smith          (813) 974-3547      carlos@cas.usf.edu                   FAO285
 XDH     Diasporas & Health Disparities*                      Deborah Plant         (813) 974-4220      plant@.cas.usf.edu                   FAO270
 XDU     Digital Music Education**                            David Williams        (813) 974-2311      dwilliams@arts.usf.edu               FAH110
 XDM     Disaster Management**                                Wayne Westhoff        (813) 974-6621      wwesthof@health.usf.edu              MDC56
                                                              Boo Kwa               (813) 974-6635      bkwa@health.usf.edu                  MDC56
 XDV     Diversity                                            E. Johanningmeier (813) 974-9495          johannin@coedu.usf.edu               EDU162
 XEE     English Education                                    Jane Applegate        (813) 974-0383      applegat@coedu.usf.edu               EDU162
 XET     Entrepreneurship***                                  Michael Fountain      (813) 974-7900      fountain@coda.usf.edu                BSN3403
 XEP     Environmental Policy & Management                    Phil Reeder           (813) 974-4292      preeder@cas.usf.edu                  NES107
 XCE     Epidemiology                                         Heather Stockwell (813) 974-4804          stockwel@health.usf.edu              MDC56
 XES     ESOL**                                               Phil Smith            (813) 974-1113      pcsmith@tempest.coedu.usf.edu        EDU162
 XFL     Foreign Language Ed: Culture & Content               Phil Smith            (813) 974-1113      pcsmith@tempest.coedu.usf.edu        EDU162
 XFP     Foreign Language Ed: Professional                    Phil Smith            (813) 974-1113      pcsmith@tempest.coedu.usf.edu        EDU162
 XGI     Geographical Information Systems                     Hyun Kim              (813) 974-4939      hkim1@cas.usf.edu                    NES107
 XGS     Geriatric Social Work/Clinical Gerontology           Cathy McEvoy          (813) 974-1940      cmcevoy@luna.cas.usf.edu             MHC1338
 XGE     Gerontology**                                        Cathy McEvoy          (813) 974-1940      cmcevoy@luna.cas.usf.edu             MHC1338
 XGF     Gifted Education**                                   Easter Curry          (813) 974- 9941     ecurry@tempest.coedu.usf.edu         EDU162
 XGO     Globalization Studies                                Darrell Slider        (813) 974-9378      dslider@cas.usf.edu                  SOC107
 XHC     Health Care Risk Mgt.& Patient Safety**              Kathryn Hyer          (813) 974-3232      khyer@cas.usf.edu                    MHC1323
 XHM     Health Management & Leadership*                      Barbara Orban         (813) 974-5131      borban@health.usf.edu                MDC56
 XHL     Health Sciences**                                    Michael Barber        (813) 974-9702      mbarber@health.usf.edu               MDC07
 XHE     Hearing Specialist: Early Intervention**             Kelly Crain           (813) 974-8334      kcrain@cas.usf.edu                   PCD1017
 XHS     Homeland Security*** (on hiatus)                     Jamie Corvin          (813) 974-6690      jcorvin1@health.usf.edu              MDC056
                                                              Tom Mason             (813) 974-6675      tmason@health.usf.edu                MDC056
                                                              Tom Mieczkowski       (813) 974-8281      mieczknow@cas.usf.edu                SOC107
 XHP     Hospice, Palliative Care & End of Life Studies       Cathy McEvoy          (813) 974-1940      cmcevoy@luna.cas.usf.edu             MHC1338
                                                                                                        	                                    	     	
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Code Name of Certificate                                 Contact             Telephone        E-mail                                Location
XHP   Hospice cont’d                                     V. Wise-Neely       (813) 974-5112   vwisenee@health.usf.edu               MDC22
                                                         Susan McMillan      (813) 974-9118   smcilla@health.usf.edu                MDC22
XHA   Humanitarian Assistance**                          Wayne Westhoff      (813) 974-6621   wwesthof@health.usf.edu               MDC56
XHY   Hydrogeology                                       Jeff Ryan           (813) 974-6287   ryan@cas.usf.edu                      SCA528
XIC   Infection Control**                                Donna Haiduven      (813) 974-6472   dhaiduve@health.usf.edu               MDC56
XEV   Informal Science Institutions: Environmental Ed    Barbara Spector     (813) 971-1856   spector@coedu.usf.edu                 EDU162
XDD   IT: Distance Education**                           James Takacs        (813) 974-9979   takacs@usf.edu                        EDU162
XFD   IT: Florida Digital Educator*                      James Takacs        (813) 974-9979   takacs@usf.edu                        EDU162
XID   IT: Instructional Design*                          James Takacs        (813) 974-9979   takacs@usf.edu                        EDU162
XMM   IT: Multimedia Design                              James Takacs        (813) 974-9979   takacs@usf.edu                        EDU162
XNS   IT: School Networks (on hiatus)                    James Takacs        (813) 974-9979   takacs@usf.edu                        EDU162
XWD   IT: Web Design**                                   James Takacs        (813) 974-9979   takacs@usf.edu                        EDU162
XTP   Interdisciplinary Transportation                   Steve Polzin        (813) 974-9849   polzin@cutr.usf.edu                   CUT100
XLS   Latin American & Caribbean Studies                 Cristina Espinosa   (813) 974-2962   espinosa@iac.usf.edu                  CPR474
XLC   Leadership (USF employees only) (on hiatus)        Sandy Cooper        (813) 974-5294   scooper@admin.usf.edu                 SVC2072
XHR   Leadership in Developing Human Resources           Bill Young          (813) 974-1861   wyoung@coedu.usf.edu                  EDU162
XMF   Marriage & Family Therapy                          Joseph Ferrandino (813) 974-0969     jferran@cas.usf.edu                   SOC107
XMT   Materials Science & Engineering                    John Wolan          (813) 974-6250   wolan@eng.usf.edu                     ENB118
XMR   Maternal & Child Health                            Kay Perrin          (813) 974-6704   kperrin@health.usf.edu                MDC56
XMI   Mathematics                                        Stephen Suen        (813) 974-9566   suen@math.usf.edu                     PHY114
XMC   Mathematics Education                              Helen Gerretson     (813) 974-2172   hpg@coedu.usf.edu                     EDU162
XMB   Med. Biochem., Microbiology & Immunology           Michael Barber      (813) 974-9702   mbarber@health.usf.edu                MDC07
XMG   Medicine & Gender                                  Nagwa Dajani        (813) 974-5724   ndajani@health.usf.edu                MDC78
XMH   Mental Health Counseling                           Carlos Zalaquett    (813) 974-8220   zalaquet@coedu.usf.edu                EDU 162
XPL   Mental Health Planning, Eval., & Accountability*   Bruce Levin         (813) 974-6400   levin@fmhi.usf.edu                    MHC2330
XMO   Molecular Medicine                                 Michael Barber      (813) 974-9702   mbarber@health.usf.edu                MDC07
XCM   Multimedia Journalism*                             Derina Holtzhausen (813) 974-6800    dholtzha@cas.usf.edu                  CIS3088
XMS   Museum Studies                                     Noel Smith          (813) 974-5866   nsmith@arts.usf.edu                   FAH110
XMU   Music                                              David Williams      (813) 974-2311   dwilliams@arts.usf.edu                FAH110
XMA   Music (Advanced)                                   David Williams      (813) 974-2311   dwilliams@arts.usf.edu                FAH110
XNM   Nonprofit Management                               Sally Beynon        (813) 974-0813   sbeynon@cas.usf.edu                   SOC107
XNE   Nursing Education                                  V. Wise-Neely       (813) 974-5112   vwisenee@health.usf.edu               MDC22
                                                         Barbara Redding     (813) 974-9236   bredding@health.usf.edu               MDC22
XNI   Nursing & Healthcare Informatics* (hiatus)         V. Wise-Neely       (813) 974-5112   vwisenee@health.usf.edu               MDC22
                                                         Deborah Cantero     (813) 396-9429   decanter@health.usf.edu               MDC22
XON   Occupational Health Nursing**                      Candace Burns       (813) 974-9160   cburns@health.usf.edu                 MDC22
XPT   Play Therapy*                                      Jennifer Baggerly   (813) 974-6714   baggerly@coedu.usf.edu                EDU162
XPS   Political Science                                  Darrell Slider      (813) 974-9378   dslider@.cas.usf.edu                  SOC352
XEL   Post Master’s Education Leadership (K-12)          Darlene Bruner      (813) 974-6039   dbruner@coedu.usf.edu                 EDU162
XLI   Post-Master’s: Library & Info Science*             Kiersty Cox         (813) 974-7291   kcox@cas.usf.edu                      CIS1040
XMF   Post Master’s Marriage & Family Therapy (hiatus) Joseph Ferrandino (813) 974-0969       jferran@cas.usf.edu                   SOC107
XNR   Post Master’s Nurse Practitioner*                  V. Wise-Neely       (813) 974-5112   vwisenee@health.usf.edu               MDC22
XPU   Public Health Generalist**                         Karen Liller        (813) 974-6685   kliller@health.usf.edu                MDC56
XPH   Public Health Policy and Programs**                Barbara Orban       (813) 974-5131   borban@hsc.usf.edu                    MDC56
XPM   Public Management                                  Sally Beynon        (813) 974-0813   sbeynon@cas.usf.edu                   SOC107
XRC   Reading Certificate & Endorsement*                 Nancy Williams      (813) 974-3460   nwilliam@coedu.usf.edu                EDU2081
XRA   Regulatory Affairs – Medical Devices***            Dolores Gooding     (813) 974-5582   gooding@eng.usf.edu                   ENB118
XRT   Rehabilitation Technology                          Tennyson Wright     (813) 974-2963   twright@cas.usf.edu                   SOC107
XRM   Research Methods*                                  Constance Hines     (813) 974-0370   hines@tempest.coedu.usf.edu           EDU162
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                                                                                                                                                 3
Code Name of Certificate                             Contact             Telephone        E-mail                    Location
XSM   Safety Management                              Peter Rentos        (813) 974-6661   prentos@healthusf.edu     CPH1121
XLM   School Library Media Specialist*               Kiersty Cox         (813) 974-7291   kcox@cas.usf.edu          CIS1040
XSE   Science Education                              Elaine Howes        (813) 974-2816   ehowes@coedu.usf.edu      EDU162
XSP   Social Marketing and Public Health             Carol Bryant        (813) 974-6686   cbryant@health.usf.edu    MDC56
XSS   Social Science Education*                      Michael Berson      (813) 974-7917   berson@coedu.usf.edu      EDU308B
                                                     Carolyn Sheffield   (813) 974-3588   ccsheffi@mail.usf.edu     EDU162
XSA   Statistical Data Analysis                      Wonkuk Kim          (813) 974-9559   wkim@cas.usf.edu          PHY114
XTC   Teaching Composition (on hiatus)               Debra Jacobs        (813) 974-9473   djacobs@cas.usf.edu       CPR358
XSL   Teaching English as a Second Language          Camilla Vasquez     (813) 974-7378   cvasquez@cas.usf.edu      CPR419
XTM   Technology Management***                       Dolores Gooding     (813) 974-5582   gooding@eng.usf.edu       ENB118
XTQ   Total Quality Management ***                   Dolores Gooding     (813) 974-5582   gooding@eng.usf.edu       ENB118
XTS   Transportation Systems Analysis***             Steve Polzin        (813) 974-9849   polzin@cutr.usf.edu       CUT100
XVI   Violence & Injury: Prevention & Intervention   Martha Coulter      (813) 974-7829   mcoulter@health.usf.edu   MDC56
                                                     Karen Liller        (813) 974-6685   kliller@health.usf.edu    MDC56
XWE   Wireless Engineering***                        Larry Dunleavy      (813) 974-2574   dunleavy@eng.usf.edu      ENB118
XWH   Women’s Health                                 Ellen Daley         (813) 974-8518   edaley@health.usf.edu     MDC56
                                                     Marilyn Myerson     (813) 974-0978   myerson@cas.usf.edu       FAO011
XWS   Women’s Studies                                Marilyn Myerson     (813) 974-0978   myerson@cas.usf.edu       FAO011




                                                                                                                               4
USFCard & USF NetID (for Distance Learning Students)

USFCard Information for Distance Learning Students:
The USFCard identifies you as a University of South Florida student.

Students use the USFCard to:
• Acquire the USF NetID and e-mail account to access on-line course materials
• Check out materials from the USF Library
• Gain access to USF athletic events
• Use the campus recreation facilities
• Receive discounts from Tampa Bay area vendors

To apply for the USFCard:
• Go to: http://www.auxsvc.usf.edu/usfcard.html.
  Click the link for Distance Learning Students.
  Pay the $10 application fee online by credit card.
• Mail or e-mail a copy or digital picture of your valid driver’s license AND
• A copy or digital picture of a second photo ID. International distance learners should send a copy of their passport.

Mail to: USF ID Card
         University of South Florida
         4202 E. Fowler Ave., AXA0094
         Tampa, FL 33620

Your USFCard will be mailed within five to seven working days.
Card numbers are e-mailed to you when the card is produced.
Please call 813-974-2357 if you have questions about the USFCard.




USF NetID Information for Distance Learning Students:
The NetID is a secure user name and password for:
       • Accessing on-line course materials from https://my.usf.edu
       • Establishing and managing a USF e-mail account

To establish a NetID:
       • Go to: https://una.acomp.usf.edu
       • Click on “Activate your USF NetID”
       • Enter either your USF-ID number, or the number on your USFCard that begins with 6400
       • Enter birthday
       • Enter last five digits of Social Security number. International students, who do not have a Social Security number
         should contact Academic Computing at help-ac@usf.edu or 813-974-1222.
       • Follow further instructions as given on the page

To access on-line courses:
       • Go to https://my.usf.edu
       • Login using your NetID and password
       • Click on the “Courses” tab at the top of the page
       • Browse through other tabs and links for course materials
       • Contact the instructor with questions relating to course materials

                                                                                                                          5
                                         All applications and accompanying
                                             materials should be sent to:
                                                                  Graduate Certificates
                                                                 University of South Florida
                                                              4202 East Fowler Ave., SVC1072
                                                                  Tampa, FL 33620-9951

                                                                   Phone: 813/974-2442
                                                                 Toll Free: 1-888-USF4YOU
                                                                      Fax: 813/974-7061
                                                               email: gradcerts@admin.usf.edu




 www.outreach.usf.edu/gradcerts
The University of South Florida is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools (1866 Southern Lane, Decatur, Georgia 30033-4097; telephone 404-679-4501; http://www.
sacscoc.org/) to award degrees at the Baccalaureate, Master’s, Specialist, and Doctoral levels, including the Doctor of Medicine.

Events, activities, programs and facilities of the University of South Florida are available to all without regard to race, color, marital status, sex, religion, national origin, disability, age, Vietnam or disabled veteran status as provided
by law and in accordance with the University’s respect for personal dignity.

				
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