MUST BE RETURNED TO THE CSIS DEPARTMENT FOR PROCESSING
REC’D AT FRONT COUNTER BY
DATE REC’D
PETITION FOR CERTIFICATE
CYBERSECURITY
12 units – Minimum of “C” Required in Each
Course Santa Monica College
PRINT YOUR NAME:
PRINT YOUR NAME EXACTLY AND IN THE ORDER YOU WANT IT TO APPEAR ON YOUR CERTIFICATE
ADDRESS:
(to mail certificate) Street Apt. No.
City
State or Foreign Country Zip Code
SMC ID. #: DATE OF BIRT
H: TELEPHONE:
(required)
EMAIL ADDR: CELL PHONE:
Note: Students who do not complete certificate requirements during filing period must re-apply.
If using coursework from other college(s), please indicate name(s) of institution(s):
Note: Students need to attach copies of transcripts from other schools when submitting this application.
Student Signature:
Date
(Required)
FOR OFFICE USE ONLY
Do Not Write Below this Line Do Not Write Below this Line Do not Write Below this Line
Required Courses (12 Units):
CS 70, Network Fundamentals and Architecture (3)
CS 73A, Fundamentals of Computer Security
(Formerly: CS 73) (3)
CS 73B, Computer Forensics Fundamentals (3)
CS 73C, Cybersecurity and Ethical Hacking (3)
*To be done in consultation with department chair or designated coordinator.
Rec’d: A & R Evaluator:
Granted: Denied: Entered:
Printed: Signed: Mailed:
