Management Branch Office of Licensing

CERTIFICATION OF MASTER’S (CACREP ACCREDITED) EDUCATION USE THIS FORM FOR PERMIT ISSUANCE PRIOR TO GRADUATION. To be completed by applicant and school where degree will be awarded (must be signed by an appropriate school official). You must upload the original completed form during the online application. SECTION 1 – To be completed by Applicant This certifies that __________________________________________________________________________ is Full, Legal Name of Applicant

enrolled in _______________________________________________________________________________ in Full Name of School and Program

___________________________________________ since the __________ day of _____________________, Location of School

Day

Month

______________________. Year

SECTION 2 – To be completed by appropriate School Official This undersigned certifies that the applicant listed above has successfully completed the CACREP accredited Master’s program, and that the applicant has or will be granted a degree on the __________ day of _____________________, Day

Month

______________________. Year

Signed This _____________ day of ________________________________________, ____________________. Day

Month

Year

By___________________________________________________________________________________________ School Official – Full Name and Title

1560 Broadway, Suite 1350, Denver, CO 80202 P 303.894.7800

F 303.894.7693 www.dora.colorado.gov/professions