Degree Attainment Award request

First name *This question is required.

Last name *This question is required.

MC number *This question is required.

MC email address *This question is required. This question requires a valid email address.

Original hire date *This question is required.

mm/dd/yyyy

Name of accredited institution: *This question is required.

Date degree conferred *This question is required.

mm/dd/yyyy

I certify that I received the above-mentioned degree from a regionally accredited institution. *This question is required. A regionally accredited institution is one that is recognized by a regional accreditation agency that oversees institutions that place a focus on academics that are state-owned or non-profit colleges or universities. Visit www.chea.org/ for more information.

I hereby confirm that all information that I have provided on this form is accurate to the best of my ability. *This question is required.

I understand falsification of this document could result in disciplinary action. *This question is required.

I understand that at any time, the College may request additional documentation to verify my use of this award. *This question is required.