This is to certify that      Student’s Name     was in regular attendance at

the   Name of School and Location from   Beginning Date to   Ending Date  

for a total of   number of months   months and  number of days   days and that

said student completed a course of study consisting of   number of hourshours. 

NOTARIZATION
I certify that these hours include only those actually completed at the above mentioned school and that said hours were satisfactorily completed. I further certify that the coursework completed at this school is acceptable for purposes of licensure in Connecticut. 

Signature of Dean or Owner        Signature          Email:   Email         
       
     
On this   Day   day of  Month    of 20   Year (YY)    .   

 First Name   Last Name   (Dean or Owner’s Name)   personally appeared

before me, who being duly sworn says that the statements made herein are true in every respect. 

Sworn to before me this    Day   day of   Month    of 20   Year (YY)    .

Signature Of Notary Public   Signature    

My commission expires   Date