Cerritos College Requisite Clearance Request Form
This form is to be used when a student believes he/she has met the requisite for a Cerritos College course in which he/she wishes
to enroll. *Submit requests to the Office of Admissions & Records or fax form and supporting documentation to (562) 467-5068.
Transcripts may be unofficial. Only approved requisites will be posted on the unofficial transcript at www.cerritos.edu/mycerritos,
within 10 working days.
Stu ID_________________Last Name______________________First Name________________________BDate__________
Home Phone ( ) ____________________ Cellular ( ) _______________________Email__________________________
*If you have previously submitted transcripts to Admissions and Records, approximate date of submission_________________
Term in which you would like to take the course(s) _________________________
1. For courses completed other than English, Reading and Math skills courses, enter the information on the lines below.
*Attach transcript, with a copy of the catalog course description. (If you are currently enrolled in the requisite, documentation of
course completion with a minimum grade of “C” or “CR” must be provided with this form.)
__________________________ _______________________ _____________________ __________________________
Cerritos course you wish to take Cerritos requisite to be cleared School where requisite was taken Course taken at other school
_____________________________ _________________________________
If more than one course Cerritos requisite to be cleared Course taken at other school
is needed to meet a requisite, _____________________________ _________________________________
list each course on a separate Cerritos requisite to be cleared Course taken at other school
line here. _____________________________ _________________________________
Cerritos requisite to be cleared Course taken at other school
2. English, Reading and/or Math skills test scores with course placements or Engl,
Reading and/or Math skills courses completed at another school, or placement tests Course Clearance Codes
completed at Cerritos prior to 2001. *Attach documentation. For office use only
_________________ Engl___________________ Engl ZZ______________
College Course placement or completed
____________________ Read______________________ Read ZZ_________________
College Course placement or completed
_____________________ Math
_______________________ Math ZZ_________________
College Course placement or completed
For options 3-5, check the appropriate box and complete section, 1 or 2 above. Math ZZ_________________
3. Other test scores; (e.g. Advanced Placement, etc.,) attach documentation.
Math ZZ______________
4. High School work; attach transcript. Chem ZZ______________
5. Other related coursework, job or life related experience, or documentation providing evidence of requisite satisfaction;
explain and attach documentation, (e.g.*transcript and catalog course description, trade affiliation documents, letter from
supervisor, copies of certificate, license, diploma, etc.)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Only approved requisites will be posted on the unofficial transcript at www.cerritos.edu/mycerritos, within 10 working days.
Student Signature ____________________________________________________________Date________________________
*Providing a catalog course description and copies of transcripts may speed up the evaluation process. Additional
course information may be requested to finalize the decision. Documents attached to this request will not be returned,
and will become the property of Cerritos College.
This form is used for the purpose of requisite evaluation only and does not meet the criteria for an official academic evaluation. To have an academic record
evaluation, only official transcripts will be accepted, and evaluations must be requested by a counselor or completed through the process of petitioning for a
Certificate of Achievement or an Associates Degree. Clearance of a requisite does not assume waiver, substitution or completion of course requirements.
Approved Denied Petition not needed More info required
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Staff Signature Date Dean’s Signature requisite entered
I UNDERSTAND AND ACCEPT that by providing my full name in lieu of the electronic signature,
I am acknowledging my agreement with the acceptance of these statements.
