Fillable Application for Certicate of Competency/ Completion (Modesto Junior College)

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Application for Certicate of Competency/ Completion (Modesto Junior College)

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  • 11 check-boxes
  • 17 other fields

Country of origin: US
File type: PDF

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Application for Certicate of
Competency/ Completion
Submit completed form by email to mjcevaluations@mjc.edu
Certicate of Competency
English for Life and Work: Elementary
(ELW 901, 902 & 903)
English for Life and Work: Procient
(ELW 904, 905 & 906)
Prociency in Arithmetic
(MATH 911, 912 & 913)
Prociency in Pre-Algebra
(MATH 921, 922, 923 & 924)
Certicate of Completion
Research Skills
(LIBR 901, 902 & 903)
I acknowledge the ocial name on record will be used as the name on the certicate.
Student Signature: Date:
Please check which certicate you are applying for
MJC Enrollment Services • 435 College Avenue, Student Services Bldg. 1st Floor • Modesto, CA 95350 • Phone (209) 575-6605
Student Information (Please list your legal name):
Last Name: First Name: Middle Initial:
Student ID: w Birthdate: Phone Number:
OFFICE USE ONLY
Comments:
Pending
Complete
Ineligible
SGRD
Email
Requirements to complete this form & successfully receive your certicate:
• Complete ONE form for EACH certicate. Please type or print clearly.
• You must apply in the term in which you expect to complete your certicate requirements.
• We recommend that you meet with a counselor before applying to ensure you have met all the requirements.
• All correspondence from the Evaluations Oce will be sent to your College Student Email ONLY.
04/2020_SJB
Requirements were/will be completed: Fall Spring Summer
Year
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Application for Certicate of Competency Completion (Modesto Junior College)

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Completed 4 September 2020

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