CERTIFICATE OF PHYSICIAN ASSISTANT EDUCATION SECTION 1 To be completed by applicant and forwarded to school where physician assistant program was completed.
This certifies that _______________________________________________________________ Full Name of Applicant
enrolled in ____________________________________________________________________ Full Name of School
_______________________________________on the ________ day of____________________ Location of School
Day
Month/Year
SECTION 2 To be completed by president / secretary / dean of school where physician assistant program was completed, and forwarded to the Office of Licensing.
The undersigned certifies that the records of this institution show that he/she attended this institution beginning on the
Day
day of
completed an Physician Assistant Program on the
Year
,
Month
Day
Year
day of
and has
Month
,
.
Signed and the college seal affixed This
Day
day of
Month/Year
.
By ___________________________________________________________________________ President
/
Secretary
/
Dean
NOT VALID WITHOUT SCHOOL SEAL NOTE TO REGISTRAR: If no school seal, please indicate above next to signature of President/Secretary/Dean.
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Sep 18, 2014 - The consummate professional, Brunson is a graduate of Jackson State. University, where he earned his bachelor's degree. He also attended.
Sep 18, 2014 - The consummate professional, Brunson is a graduate of Jackson State. University, where he earned his bachelor's degree. He also attended.
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