Connecticut - Bucks County Community College



International Fire Service Accreditation Congress

Application for Degree Completion Certificate

Cost: $15 (US) per certificate and IFSAC seal. Note: seal numbers are unique and cannot be duplicated – one certificate and seal per degree awarded can be ordered.

Student Applicant Instructions: To apply for entry into the International Registry of the IFSAC Degree Assembly and receive a degree completion certificate under the policies of the institution listed below, please complete the following information in the unshaded sections of this form: mailing address, payment total, and payment type. Faxed or emailed orders will not be accepted. Mail application along with payment directly to:

International Fire Service Accreditation Congress

Oklahoma State University

1723 West Tyler Avenue

Stillwater, OK 74078-8075

(405) 744-8303

Note: All shaded areas are to be filled out by the graduating institution representative. Any alterations made within the shaded areas will immediately void this application.

Graduating Institution/Program (Please print/type legibly)

Applicant Information (Please print/type legibly)

Name (as it should appear on certificate):

Mailing Address:

Telephone #:

Date of Birth:

|Degree Awarded |Date of Graduation |Initials of Entity Agent |Unit Price | |

|(i.e., BS, Fire Science) | | | |Total |

| | | | | |

| | | |$15.00 |$15.00 |

|(Oklahoma residents add 8.813% sales tax) Tax: | |

|Total: | |

As an authorized agent of the above named institution, I hereby confirm that the individual named on this application is eligible to receive a certificate with an IFSAC seal and entry into the IFSAC Degree Assembly International Registry for the program of study listed and initialed above.

Agent Signature: Initials: Date:

|Payment method: |Check Credit Card (Visa or MasterCard accepted) |

|Cardholder Signature: | |

|Credit Card No.: | |Exp. Date: | |CCV: | |

International Fire Service Accreditation Congress

Oklahoma State University

1723 West Tyler Avenue

Stillwater, OK 74078-8075

(405) 744-8303



(Office hours: 8:00 AM to 5:00 PM CDT/CST, Monday through Friday)

Certificate Information

All information on the front of this application must be completed in order for an IFSAC Degree Completion Certificate to be issued. Shaded areas are to be completed/signed by an official agent of the degree program.

A certificate will only be issued to individuals who have been awarded a degree through an IFSAC accredited entity. One seal will apply to only one degree program. Upon verification of the degree completion information on the application, an IFSAC certificate will be prepared and mailed.

The certificate contains the original degree completion and international registry seal number and may be used to verify an individual’s entry into the IFSAC Degree Assembly International Registry.

Certificate Ordering Information

All orders must be prepaid at $15.00 per certificate.

Faxed or emailed orders will not be accepted. All orders are to be mailed with proper payment to the address shown on this form.

Order forms without the proper agent signatures and initials will not be accepted. All shaded areas are to be completed by the appropriate official or staff person of the degree program.

Only one degree program per certificate (i.e. Bachelor of Science, Fire Science).

Please allow 4 to 6 weeks for delivery.

Return Policy: IFSAC guarantees this certificate. If you are not fully satisfied, you may return your purchase within 30 days for a full refund or exchange.

Payment can be made by check, money order, or credit card.

Make checks and money orders payable to the International Fire Service Accreditation Congress, or IFSAC.

If using MasterCard or Visa, complete all credit card information on the front of this form.

If you have any questions regarding your order, call IFSAC Administration at (405) 744-8303.

All orders are subject to acceptance by the International Fire Service accreditation Congress Administrative Office, Stillwater, Oklahoma.

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