Micro-Credential Form
New undergraduate students, new graduate students, and matriculated graduate students can use this form to declare a micro-credential.
Which micro-credential are you pursuing?
*
Please Select
Advanced Environment & Sustainability (A&S)
Central Service Technician (Blue Ash)
Computer Support Specialist (Clermont)
Design Strategy Micro-credential (DAAP - graduate)
EKG (Electrocardiogram) Technician (Blue Ash)
Electronic Health Records (Blue Ash)
Electronic Health Records Specialist (Clermont)
Engineering Education Research (CEAS)
General X-Ray Machine Operator (Blue Ash)
Health Unit Coordinator (Blue Ash)
Introduction to Environment & Sustainability (A&S)
Nursing Education (Nursing)
Patient Care Technician (Blue Ash)
Personal Health and Wellness (CECH)
Personal Training Micro-Credential (UCBA)
Phlebotomy (Blue Ash)
Presentation Applications Specialist (Clermont)
Programming Primer: Fundamentals & Foundations (Clermont)
Sport Performance and Wellness (CECH)
Spreadsheet Applications Specialist (Clermont)
Sustainability (A&S)
Systems Leadership (Nursing)
Teaching Engineering (CEAS)
Transdisciplinary Innovation Models (CCPS)
Word Processing Applications Specialist (Clermont)
Writing in the Workplace (Clermont)
Term in which you plan to enroll
*
Fall 2025
First Name
*
Middle Name
Last Name
*
Previous Names
Current or previous UC Student?
*
Yes
No
UC ID# (if applicable)
Street Address
*
Street Address Line 2
City
*
State / Province
*
Postal / Zip Code
*
Phone Number
*
-
Area Code
Phone Number
Date of Birth
*
-
Month
-
Day
Year
Date
Legal Sex
*
Male
Female
If you are 18 or older, are you registered with the Selective Service (www.sss.gov)?
*
Yes
No
Selective Service Number
*
Years & Months of Consecutive residence in Ohio immediately preceding today:
*
Current UC or personal email
*
US Citizen?
*
Yes
No
Ethnicity
Hispanic/Latino
Not Hispanic/Latino
Race (check all that apply)
*
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/ Pacific Islander
White
Other
High School Name, City and State
*
High School Graduation date
*
-
Month
-
Day
Year
Date
Unofficial Transcript
*
Browse Files
Please upload an unofficial transcript that shows an earned Bachelor of Science in Nursing (BSN). The institution that conferred your degree must be both regionally accredited AND Commission on College Nursing Education (CCNE) or Accreditation Commission for Education in Nursing (ACEN) accredited.
Cancel
of
RN Licensure
*
Browse Files
Please upload a copy of your current, active, unrestricted Registered Nurse (RN) licensure with no disciplinary action.
Cancel
of
Since 9th grade, have you been disciplined at a school you have attended for academic or behavioral misconduct (Disciplinary actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion.)
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Yes
No
If yes please give the approximate date of each incident, explain the circumstances, and reflect on what you learned from the experience.
*
Have you ever been found guilty or convicted of a misdemeanor, felony, or other crime? (Note that you are not required to answer "Yes" to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.)
*
Yes
No
If yes please provide an explanation of the conviction.
*
In alignment with the state regulations enforced for our graduate programs, the college cannot accept micro-credential applications from individuals who plan to live in the following states while a student: Arizona, Louisiana, Massachusetts, New York, Oregon, Rhode Island, Tennessee, and Washington. Do you plan to live in one of the previously-mentioned states while seeking this micro-credential?
*
Yes
No
I understand that I am requesting to add a micro-credential.
*
I Understand
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