University Honors Program
Fulfillment of
Departmental Honors Requirements
Faculty, please
print, fill out, and send this form to the University Honors Program office.
Student Data
Name (as you would like it to appear on the certificate):
_____________________________
UID: _________________________________________________________
Date of graduation: ______________________________________________
Major department: _______________________________________________
Academic Information
Student has
completed or is expected to complete by __________________ (quarter/year) all of the requirements for graduation with
Honors in _________________________________________ (major).
To graduate
with Honors, this student has done the following:
(please list any special courses, examinations, independent studies, or Honors
theses/papers)
1.
2.
3.
4.
Project
Title:___________________________________________
_______________________________________________
Advisor: ________________________________________
Advisor/Dept. Chair's signature: _________________________________
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