Application for Los Medanos College Certificate of Competency
2019 - 2020
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Last Name: First Name:
Address:
City: State: Zip:
Phone Number: ( ) Student ID:
Check the certificate(s) you are applying for:
English As A Second Language (ESL)-Non-Credit
Basic Vocabulary and Reading (108 Hours)
Essential Pronunciation and Conversation (108 Hours)
___ Foundational Grammar for General Communications (108 Hours)
___ Fundamental Writing Skills Certificate of Competency (108 Hours)
Mathematics-Non-Credit
Elementary Algebra and Arithmetic (234 Hours)
Note: All hours must have been completed at Los Medanos College. No substitutions allowed.
Signature: Date:
Please submit this form to the Admissions & Records Office upon completion of all
courses applicable to the certificate. Your certificate will be mailed to you upon
verification of requirements.
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