Request For Department Discipline Skills Certificate Template
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1
2Request for Department Discipline Skills Certificate
PLEASE PRINT
Name:
_____________________________________________________________________________ Student I.D. No.__________________________________
Last
First
MI
Address:
___________________________________________________________________________________________________________________________
City
State
Zip Code
Contact Number ______________________________________
Email Address ____________________________________________________________
Department/Discipline _________________________________________________________(Select from the list of certificates on the reverse side.)
Certificate Requested __________________________________________________________ TOP/Major Code _______________________________
Congratulations on your completion of an East Los Angeles College Certificate Program. In order to receive the actual certificate, you must complete
this form and include the necessary items as stated in the Certificate Application Procedure on the back page of this form. Verify you have completed
all of the following general requirements before submitting your request.
ALL GRADES MUST BE POSTED ON TRANSCRIPTS PRIOR TO SUBMISSION OF REQUEST.
GENERAL REQUIREMENTS
The following requirements must be fulfilled before certificate(s) can be granted by East Los Angeles College.
Grade of “C” or better in all courses required for certificate.
1.
2.
All courses acceptable for credit must be approved by the Western Association of Universities and Colleges or by a comparable accrediting
agency. Requirement shall be determined by the Department Chair for the discipline. Transcripts from institutions outside the Los Angeles
Community College District must be mailed directly to the Admissions and Records Office. No hand delivered transcripts accepted.
3.
Course required for the Certificate must be completed at East Los Angeles College, unless otherwise approved.
4.
All courses fulfilling the requirements for one certificate may be applied other certificates.
Please read certificate application procedure on the reverse side before continuing.
List all the required courses for the Certificate requested. Indicate when and the college the courses were completed. OFFICIAL SEALED TRANSCRIPTS from
institutions outside of the Los Angeles Community College District must be MAILED directly to the Admissions and Records Office. No hand delivered transcripts
accepted.
If you require additional space, please attach another request form.
GPA
Course
Semester
College
Grade
(For Dept.
Completed
Where Completed
Received
Chair Use)
________________________
__________________
_________________________
__________
________________________
__________________
__________________________
__________
________________________
__________________
_________________________
__________
________________________
__________________
_________________________
__________
________________________
__________________
_________________________
__________
________________________
__________________
_________________________
__________
________________________
__________________
_________________________
__________
________________________
__________________
__________________________
__________
Cumulative GPA:
Student’s Signature _____________________________________________
________________________________
Date
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