Associate Degree Petition & Certification -- Plan B
CSU Certification
(To be completed after 30 degree-applicable units)
NAME: ________________________________________________________________________________________________________
Print clearly and EXACTLY as you want your legal name to appear on the diploma
TELEPHONE #: _____________________________________________________ STUDENT ID #: ___________________________
E-MAIL ADDRESS: ___________________________________________________
(12 units must be completed at Santiago Canyon College with 6 of those in the Academic Program.)
_____________________________________________________ / _______________ CATALOG YEAR _________________
Academic Program Program Code Must be one of continuous enrollment or current catalog
December (Fall)
(Spring) Year _______________
August (Summer)
If yes, list all the institutions attended: _______________________________________________________________________________________________
All official transcripts from other colleges or universities must be on file at Santiago Canyon College to process the petition.
CSU Certification Requirements
Academic Program Requirements
(Must complete this section if applying for an associate degree)
List Courses
List Courses
C1 or C2
D ____
E1 / E2
American Institutions Requirement for California State Universities ONLY
++ Not required for SCC graduation or CSU Certification ++
List Courses
US 1
US 2 / 3
_________ Please initial
I give my permission to have my name printed in the
commencement brochure and Board of Trustee docket.
Yes No
Student’s Signature: ____________________________________________________________ Date: ____________________________
(petitions received after the deadline will be processed for the following semester)
Have you attended any other colleges or universities? YES NO
Please check one -
PARTIAL Certification
Petition for CSU Certification / degree to be awarded at the end of the following semester:
I certify that the information above provided is complete and accurate to the best of my knowledge.
SCC | GRAD DEPT | TG 07/22/2020
CLEAR - Majors
Instructions for Completing the Petition to Graduate form – Plan B
Name: Write your name as you want it to appear on your diploma. Must use legal name.
xamples: John Doe, Jonathon Doe, John H. Doe Jr., John Henry Doe)
Address: Keep your address current in our computer system. Your diploma and commencement information
will be sent to that address. You can go online to change your address.
Student ID #: You must include either your Student ID number
I am applying for an associate degree and CSU Certification: If your petition if for both CSU Certification
and an associate degree please indicate by selecting the corresponding box. Indicate if you plan to
complete an approved associate of arts for transfer or associate of science for transfer.
Academic Program: This is only if you plan to earn an associate degree at SCC. Please indicate what
program you are completing for your AA/AS (local) or AA-T/AS-T (transfer) degree
Program Code: This is the corresponding code to your academic program found in the catalog
Catalog Year: Use current catalog year. If you want to use catalog rights to a previous year, enter the
year you want the Graduation Office to use when processing your petition.
I am applying for CSU Certification ONLY: If petitioning for CSU Certification ONLY please indicate by
selecting the appropriate box.
Full vs. Partial Certification:
If you plan to complete all of the requirements necessary for CSU Certification prior
to transferring, you should circle Full Certification
If you plan to transfer before all requirements have been met, you should circle
Partial Certification
Please note: If a partial certification is given, the student cannot return later to complete the
missing requirements for full certification
Petition for CSU Certification and/or degree to be awarded at the end of the following semester:
What semester will you complete all of the requirements needed to graduate?
(You must also meet the appropriate deadline.)
Have you attended any other colleges or universities: We need official transcripts from all schools you
attended other than Santiago Canyon or Santa Ana College. Official transcripts are needed even if the
coursework will not be used toward your degree.
CSU Certification:
List the course title in the correct area and indicate one of the following:
the grade (Grd) you received
if your are currently taking the course, mark (IP) for in progress
If you are not currently enrolled in a course to meet the area do not list a course just
mark the column “need”
Use the catalog and a copy of your transcript to complete this section
Academic Program Requirements:
List the courses required for your major as listed in the catalog.
Use the columns to indicate your grade (Grd, units, if your are currently enrolled in the course (IP), and/or
if you still need the course (need)
American Institutions Requirement:
This is not required for CSU Certification. It is a graduation requirement at the CSU campuses and can be
completed at the community college prior to transfer.
Commencement brochure:
Even if you do not participate in commencement (graduation ceremony) your name can still be included
in the commencement brochure
If you want your name included in the commencement brochure, please indicate “Yes” and initial
If you do not want your name to be included please indicate “No” and initial
If you do not complete this area your name will be included in the commencement brochure
Sign and date the petition:
Submit the completed petition to the Admissions and Records Office
You are encouraged to meet with a counselor if you have questions about completing this form.