I got this from the internet... this sample is from the Philippines.
NAME OF UNIVERSITY
(Date)
CERTIFICATION
This is to certify that ENGLISH IS THE MEDIUM OF INSTRUCTION at the (name of the University)
This certification is hereby issued upon the request of _____NAME_____ who was conferred the degree of (degree program) at the (name of University) on (date of graduation). Having been granted Autonomy status, the (name of University) has complied with the criteria in CHED memorandum Order No. 32,s.2001 dated Sept. 25, 2001 granting benefit of exemption from the issuance od Special Orders to selected Private Higher Education institutions.
This is to certify further that (Ms./Mr. Surname) has enrolled in (degree program) of the (name of University) department of (department name) from the (Semester school year) to the (Semester school year).
Signed by the registrar.
I hope this helps!