DE ANZA COLLEGE APPLICATION FOR CERTIFICATE
SID: Award Date: Fall Winter Spring Summer 20
Phone: Email:
PRINT NAME AS IT SHOULD APPEAR ON CERTIFICATE
Name: Other names used? List below:
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Street:
City: State: Zip:
Certificate of Achievement
Certificate of Achievement-Advanced
English proficiency met. How? Math proficiency met. How?
To Be Completed:
Student Agreement
I agree to notify the Evaluation Office at (408) 864-8651 or 8288 or 8375 if there are any changes to this application. I understand I
must complete courses in progress to meet the requirements for the certificate. It will be my responsibility to file another
application if I do not fulfill the requirements pending.
Student Signature Date
Final Action – Evaluation Office Only
Approval:
Date:
Certificate mailed:
Verified by:
A. List other colleges attended only if courses
are required for the certificate.
Revised 2/18/15
Submit to: Admissions and
Records Drop Box, located outside
south
entrance of Student and
Community Services Building.
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• Attach a Degree Works audit showing
completion of program to application.
• Submit application with audit in the Admissions
and Records drop-box located in front of
Bookstore entrance near where A&R is located.
• Attach photocopies of CPR and 1
st
Aid
certifications if required for Child Development,
Health Technologies or Massage Therapy
programs.
• Approved petitions for course
substitutions/waivers must be on file in A&R
prior to submitting application.
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