Form 2 - Certification Of Education Page 2
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2SECTION II : CERTIFICATION OF EDUCATION
INSTRUCTIONS TO REGISTRAR:
Please complete Section II, attach an official transcript and return this form directly to the Office
of the Professions at the address shown below.
DO NOT RETURN THIS FORM TO THE
APPLICANT.
DEGREE RECIPIENT
It is hereby certified that: ______________________________________________________________________________________________
(Name of applicant)
was awarded the degree of ________________________________________________________ on the date of _____ / _____ / _____,
mo.
day
yr.
for technical study in manual or machine shorthand reporting.
DESCRIPTION OF THE PROGRAM THE APPLICANT COMPLETED
(1)
Program title: ______________________________________________________________________________
(2)
Length of program: ___________________________________________________
(3)
Date of applicant's admission: _____ / _____ / _____
Date of Completion/Withdrawal: _____ / _____ / _____
mo.
day
yr.
mo.
day
yr.
(4)
Years of education and credential required for admission: _________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Note:
Please attach an official transcript or marksheet giving courses completed by year including grades and a syllabus of
the course of studies completed.
CERTIFICATION
(To be completed by the Registrar)
I hereby certify that to the best of my knowledge and belief the foregoing is a true statement of the educational record of the applicant named above.
Signature: ___________________________________________________________________
Date: _____ / _____ / _____
mo.
day
yr.
Type or print name: ___________________________________________________________
(SCHOOL
Title or official position: ________________________________________________________
SEAL)
Institution: ___________________________________________________________________
Location: ____________________________________________________________________
Telephone number: ____________________________________________________________
Fax number: _________________________________________________________________
E-mail address: _______________________________________________________________
New York State Education Department, Office of the Professions, Division of Professional Licensing Services,
RETURN TO:
Certified Shorthand Reporting Unit, 89 Washington Avenue, Albany, NY 12234-1000.
April 2003
FORM 2, PAGE 2 OF 2
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