FLORIDA INTERNATIONAL UNIVERSITY
COLLEGE OF NURSING AND HEALTH SCIENCES

GRADUATE CERTIFICATE PROGRAM
ACADEMIC PROGRESSION FORM--FAMILY FOCUSED HEALTH CARE ACROSS CULTURES

DATE ___________________

NAME ______________________________________ SSN _________________________

ADDRESS

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

HOME PHONE ______________________ WORK PHONE _________________________

_____  COPY OF STATE OF FLORIDA RN LICENSURE RECEIVED

_____ TRANSCRIPTS RECEIVED

_____ DOCUMENTATION TO WAIVE REQUIREMENTS RECEIVED (Transcripts, course syllabi, faculty validation letter, etc.)

COURSES REQUIRED:
Course number/course name/semester to be taken (If requirement is waived, advisor must identify course equivalent and source)

STUDENT HISTORY:

BSN FROM _________________________________________ GRADUATED __________

MSN-OTHER DEGREES _____________________________________________________

CLINICAL SPECIALTY ______________________________________________________

FACULTY REVIEWING ___________________________ DATE EVALUATED ________ 

COMMENTS:

__________________________________________________

Advisor Signature