Office Use Only: SACP SGRD UACF
Counselor Signature (required): Date:
Application for Certificate of Achievement
Complete form and return to:
Columbia College, Admissions & Records
11600 Columbia College Drive
Sonora, CA 95370
Fax (209) 588-5337
Student ID# Birth Date Semester of completion Year
(see catalog for deadline dates)
I wish my name to appear on my certificate as follows:
Last Name First Middle
I wish to apply for
Title of Certificate EXACTLY as it appears in the catalog
Catalog year I am following:
My mailing address:
Street Address/P.O. Box City State Zip Code
Permanent e-mail address: Phone:
(Inlcude area code)
I authorize Columbia College to print my name in the commencement program and to release my name to local newspapers.
Yes No
In order to have this appl
ication evaluat
ed, I understand it is MY RESPONSIBILITY to have official transcripts from ALL
colleges on file at Columbia College. I certify that the information contained in this application is true and accurate to the
best of my knowledge.
Using other transcripts – please list:
Signature (required): Date:
No more than 30% of the courses required for the certificate may be fulfilled with parallel courses completed at other accredited institutions.
Office Use Only: Late Applications:
OTC Letter SREP Eligible GRAD Info
Mail Cert. Date: Eval. Prelim. Ineligible GRAD Committee
Eval. Final CC A&R 3/18/15 JN
Not valid without counselor signature
Not valid without student signature
