CSU GE / IGETC CERTIFICATION REQUEST
Name:
Last First M.I. Maiden/Previous Name
Student ID: Date of Birth:
Email:
Phone:
A copy of your completed certification will be mailed to you (for your records) at the address listed below:
Student’s Address:
Street Number/Name City State Zip Code
SELECT ONE:
CSU GE Certification
IGETC Certification
CSU
UC (Official high school transcripts required if high school
coursework is used to satisfy foreign language proficiency.)
SELECT ONE: Are you using AP/IB/CLEP test scores?
Send certification immediately Yes * No *(If yes, official test scores must be on file)
Send certification after current grades are posted: Do you have college coursework outside LRCCD?
Fall Spring Summer 20___________ Yes * No *(If yes, official transcripts must be on file)
SEND CERTIFICATION TO:
College:
Dept:
Address:
Street Number/Name City State Zip Code
List additional college to send certification (if necessary):
College:
Dept:
Address:
Street Number/Name City State Zip Code
By signing this document, you are acknowledging that Folsom Lake College is authorized to send your certification to
the above college(s) and the CSU GE or IGETC Certificate of Achievement will be posted to your
FLC transcript if
certificate requirements are met as outlined in the college catalog. NOTE: Partial certifications are not posted to transcripts.
Student’s Signature Date
FOR A&R OFFICE USE ONLY:
Date Certification(s) Mailed to College: A&R Staff Initials:
Received in Evaluations:
FLC Residency Met: Semester: Initial DB: Posted to Transcript: Final DB:
Revised: August 2017
