MUST BE RETURNED TO THE CSIS DEPARTMENT FOR PROCESSING
REC’D AT FRONT COUNTER BY PETITION FOR CERTIFICATE
DATE REC’D
Entry Level Programmer
12 units – Minimum of “C” Required in Each
Course Santa Monica College
PRINT YOUR NAME:
PRINT YOUR NAME EXACTLY AND IN THE ORDER YOU WANT IT TO APPEAR ON YOUR CERTIFICATE
ADDRESS:
(to mail certificate) Street Apt. No.
City
State or Foreign Country
Zip Code
SMC ID. #: DATE OF BIRTH:
TELEPHONE:
(required)
EMAIL ADDR: CELL PHONE:
Note:
Students who do not complete certificate requirements during filing period must re-apply.
If using coursework from other college(s), please indicate name(s) of institution(s):
Note: Students need to attach copies of transcripts from other schools when submitting this application.
Student Signature: Date
(Required)
FOR OFFICE USE ONLY
Do Not Write Below this Line Do Not Write Below this Line Do not Write Below this Line
Required Courses (3 Units):
*Substitute Course/School
CS 3, Introduction to Computer Systems (3)
Select any 3 courses (9) from the following:
CS 15, 17, 18, 19, 20A, 20B, 30, 32, 33, 34A,
CS 37, 50, 51, 52, 53A, 53B, 55, 56, 80, 81,
CS 82, 83, 83R, 85, 86, 87A
*To be done in consultation with department chair or designated coordinator.
Rec’d:
Granted:
Entered:
Printed:
Dept. Chair:
Denied:
Signed:
Mailed:
