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A. M. A. Ph. D. K. CHECK THE APPROPRIATE STATEMENT S AND COMPLETE Applicant graduated on / / L. IF EDUCATION PROGRAM WAS COMPLETED IN LESS THAN THE NORMALLY REQUIRED TIME PLEASE EXPLAIN IL486-1859 09/09 DN ED-DEN Certi cation of Education - Page 1 of 2 Print Name of School Of cial Signature of School Of cial SCHOOL SEAL OR NOTARY SEAL NOTE If the institution does not have a school seal this form must be notarized. Subscribed and sworn before me t.

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