Distribution: Campus Residency Office
San Diego Community College District
Active Military Duty Certification
For Spouses and Dependents
City Mesa Miramar ECC
In accordance with the California Education Code § 68074, the Commanding Officer or Personnel Officer
of the serviceman’s command is requested to furnish the following specified information from the
serviceman’s official military personnel record and to personally sign and affix the command seal thereto.
The serviceperson is requested to make no entries on his/her own certification form.
Serviceperson’s Home of Record:
This is to certify that:
Has been stationed at present duty station:
City: State: since: Month Day Year and is
Expected to be at the above duty station until: Month Day Year
The Serviceperson’s active duty assignment immediately previous to the above was:
Duty Station: City: Date:
The most recent date of enlistment or re-enlistment was:
Enlistment Expires: Month Day Year
Serviceperson’s Spouse or Dependent Statement
Name: is the spouse/dependent of the serviceperson name above.
Spouse/Dependent Social Security #:
Signature Date
I, the undersigned, do hereby certify the above to be true and accurate and was copied by me
from the official military personnel records of the serviceperson.
Signed this date: Month Day Year
Commanding Officer or Personnel Officer:
Name: Rank: