Application for Advanced Skill Set Certificates

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Your name will print as it is in our system. Please check your Self Service Banner for reference.
Full Name*
First Middle Last
Student ID*
All diplomas will be mailed to your address in the system. Skill Sets are awarded monthly so diplomas are mailed approximately one month after submission, if requirements are met. If you need to update your address, you may do so in Self Service Banner or with help from your advisor.
Personal Email Address*

Please use a valid email address that is checked often.
Advanced Skill Set Information
Campus*
- Greenbrier Valley Campus
- Mercer County Campus
- Nicholas County Campus
- Raleigh County Campus
Name of Skill Set*
Advisor*
Please ensure your advisor submits a copy of your Skill Set Evaluation Sheet with this application. I understand that completing an Advanced Skill Set Certificate does not make me eligible to participate in the graduation ceremony. Students applying for the Phlebotomy Technician Skill Set Certificate must also send a copy of their National Phlebotomy Certificate with the application.
Attachment of National Phlebotomy Certificate
Accepted file types: doc, docx, pdf.
Please send a PDF or Word document.
By initialing here, I certify that my electronic signature above has all the legal standing of a regular signature.*

Last Updated On: 24th April, 2018

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