Student ID# First Last
Print exactly how your name should appear on certificate
First Middle Last
Cert. of Achievement Cert. of Achievement-Advanced
Requirements in progress Term Any additional documents needed for your application?
• Approved course substitution petitions (submit before applying)
• Child Development, Health Tech., and Massage Therapy majors: attach
a copy of front and back of current First Aid & CPR (write your ID# on copy)
• Official transcript not yet evaluated: school __________________________
9/27/2019
For Award Quarter: Fall Winter Spring
Summer Year 20______
Student Agreement
I agree to notify the Evaluations Office at evaluationsda@deanza.edu of any changes to this application. I understand I
must complete any required in-progress courses. It is my responsibility to submit another application if I do not fulfill
the requirements pending.
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X I agree.
If meeting major requirements from an old catalog year, enter the year here: _____________
Please visit the Counseling and Advising Center if you have any questions.
ex.
2015
-16
e) Timeline: the final certificate review, award and issue
process begins after the quarter ends. The process takes
approximately three (3) months to complete; after that time
eligible students will be emailed about certificates.
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Applying and timeline
a) Confirm your certificate completion status in DegreeWorks; check with a counselor if you need assistance.
b) Apply during the quarter in which you will complete all of your certificate requirements.
c) Application due dates: Fall – December 1st , Winter – March 1st, Spring – June 1st, Summer – August 1st
d) Submit completed application to evaluationsda@deanza.edu, the Admissions and Records office, the
Admissions and Records drop box, or your counselor.
Note: this could delay your application
Certificate information (choose one)
sign or type your name
Award date:
Verified by:
Date verified:
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CHOOSE your major from the drop-down list. If you major does not appear, please see a counselor.
Certificate Application
Download and open this form with Adobe viewer software to complete and save.
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No Yes
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With honors:
SAVE & check major after saving
