Which certificate program are you applying for? (HRD, CCTL, or eLearning):

First Name: Middle Initial:    

Last Name:

Street Address Line 1:

Street Address Line 2:

City: State:

Zip Code/Postal Code:

Country:

Phone Number (with area code):

Employer:

Current Position/Title:

Email Address:

Date of Birth :

A bachelor's degree is required for this certificate program. You will need to provide official transcripts from any college or university you have attended. "Issued to Student" copies are not considered official. Transcripts should be sent directly from your institution(s) to the address below:

Department of Human Resource Education
351 Education Building
1310 S. 6th Street
Champaign, IL, 61820

We understand that this is not immediately available. Therefore, please provide your academic history, listing all colleges/universities attended, degrees awarded, and the year of receipt.

Cumulative GPA:

Briefly explain your goals in enrolling in this certificate program.

When would you like to enroll in this program?