Use additional pages as needed. (If you have earned credits from multiple educational systems that use different credit units, e.g. semesters and quarters, you must convert all credits to one type of unit.) Grade Course Course Lab / No. of Grade College or University Term & Year Points Prefix & No. Title Practicum Credits Earned Earned Total Totals Grade Credits Points I certify the information I have provided in this application is true and accurate and recognize any false or incorrect statements made herein will be grounds for my dismissal from the program. I understand I must provide an original copy of a signed Verification Statement substantiating completion of academic requirements prior to start date of program. Date Signature Instructions for Completing Grade Point Averages
Use additional pages as needed. (If you have earned credits from multiple educational systems that use different credit units, e.g. semesters and quarters, you must convert all credits to one type of unit.) College or University Course Prefix & No. Course Title Lab / Practicum Term & Year No. of Credits Grade Earned Grade Points Earned Totals Credits Total Grade Points I certify the information I have provided in this application is true and accurate and recognize any false or incorrect statements made herein will be grounds for my dismissal from the program. I understand I must provide an original copy of a signed Verification Statement substantiating completion of academic requirements prior to start date of program. Date Signature Instructions for Completing Grade Point Averages
2014-DICAS-DI-Program-Application-Form.docx