Application for Graduate Certificate in Program Evaluation (Add-on)

Fields marked (*) are required.

Name:*

Student ID#:*

UM Email:*

Phone:*

Address:*

City:*

State:*

Zip:*

Current UM Graduate Program:*

Program Advisor:*

Please indicate whether you have taken any of the following courses at UM:*

Course Number Course Name Taken at UM?
EDRS 601 Educational Statistics I
EDRS 604 Introduction to Qualitative Research
EDRS 606 Program Evaluation I
EDRS 607 Program Evaluation II
EDRS 608 Survey Research Methods
EDRS 699 Internship in Program Evaluation

Please list courses, other than those listed above, that you have taken at the University of Mississippi or other accredited institution that you believe may be equivalent to courses listed above. Note that, with program evaluation certificate coordinator approval, up to six hours (two courses) may be transferred in to the certificate.

Course Number Course Name Semester/Year Taken Institution Grade Received Required for Current Grad. Program?