VIERA Department Information Form

Department Contact

Please note – this contact will be the only person in the Department authorized to have administrative access to all student information and status within the program’s online page. Further this will be the individual with whom the certificate program’s administrative staff will connect for information, questions and concerns related to the certificate program as it relates to your department’s members.

I declare that I will maintain confidentiality of all student information. In addition, I confirm that, as the “authority having jurisdiction”, my department maintains responsibility for the health and safety of all members participating in a certificate program.

Consent to the above statement
Program requested (Check all the programs that your members will be using)



Last updated: October 3, 2019

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