S:\Admissions\Current Forms\Petition for Certificate Form March-11.docx
Current Address
Street: _______________________________________
City: ________________________________________
State: ______ Zip Code: __________
Home Phone: (_______)__________________
Email: ________________________________________
_________________________________
If you will be moving after the end of semester, please give us the
address that your certificate should be mailed to approximately 3
months after the end of the semester:
Street: ________________________________________
City: _________________________________________
State: ______ Zip Code: ________ Country: _____
Move Date: _____________________
Please check one: Certificate of Achievement Certificate of Accomplishment
Title of Certificate: _____________________________________________________________________________________
Submit one form for each certificate applying for - see back for list of certificate titles
Admissions and Records
321 Golf Club Rd. Pleasant Hill, Ca. 94523
925.685.1230 fax 925.242.0856
Petition for Certificate of Achievement/Accomplishment
1. Please print your name exactly as you wish it to appear on your certificate.
2. Only one graduation ceremony is held per academic year. It takes place at the end of the spring semester. Information
regarding the ceremony is mailed in May.
3. If you wish to receive college credit towards a course(s) taken at another institution, it is your responsibility to request that
the official transcript be sent to the Admissions and Records Office at Diablo Valley College PRIOR to your request for a
certificate evaluation. If you are currently enrolled in courses at another college, please attach a copy of your class schedule
to this application, and ensure your official transcripts are submitted by the end of the semester.
4. Sign the petition and submit it to the Admissions and Records Office by the deadline specified in the schedule of courses.
Coursework shall be completed as stated in the DVC College Catalog. Students must meet the minimum GPA requirements.
Certificate requirements must be met, or in progress during the current semester before submitting the form. If you are not sure
that you have completed all the requirements, please consult your Department advisor. Residency requirements must be met
according to the certificate guidelines in the catalog. If you are denied a certificate, reapply during your final semester.
Name: _______________________________________________________________________________________________________
(Print name clearly as desired on the Certificate)
ID # ___________________________ Date of Birth: _______________ Male Female
Which semester will you be completing your degree requirements? _________________________________
Please list the first semester of attendance at DVC: _______________________________________________
Check if any of the following applies:
Other Colleges Attended with coursework that applies to your certificate: _________________________________________
Substitution of Graduation Requirement-Course: _________________________________
___________________________________________________ _________________
Student’s Signature Date
Office Use Only:
1
st
Evaluation: End of Semester Evaluation (if necessary):
Major: Met In Progress Major: Met Did Not Complete
Units: Met In Progress Units: Met Did Not Complete
GPA: Met GPA: Met Did Not Meet
Initial Notification (Date:)______________ Final Notification (Date:)________________
Status: Complete In Progress Eligible Denied Status: Complete Denied
Initials: _________________ Date:________ Initials: _________________ Date:________
Computer Science, Advanced Java Programming
click to sign
signature
click to edit
S:\Admissions\Current Forms\Petition for Certificate Form March-11.docx
Certificate of Achievement/Accomplishment
Achievement
Addiction Counseling
Addiction Studies
Administration of Justice
Allied Health
Allied Health Fundamentals
Architecture Technology
Art Digital Media-Character Animation
Art Digital Media-Digital Audio
Art Digital Media-Digital Imaging
Art Digital Media-Motion Graphics
Art Digital Media-3D Modeling & Animation
Art Digital Media-Web Design
Broadcast Communication Arts
Business
Accounting
Advanced Accounting
Bookkeeping
Business Core Transfer
Business Marketing
General Accounting
General Business
Advanced General Business
Management Studies
Office Professional
Real Estate
Retailing
Small Business Management
Wealth Management
CSU General Education Breadth
Communication Studies
Computer Information Systems-Core
Computer Information Systems-Database Management
Computer Information Systems-Project Management
Computer Information Systems-Web Graphics
Computer Information Systems-Web Technology
Computer Network Technology
Microsoft Windows Systems Administration
Computer Science
Computer User Support
Computer & Information Science
Microcomputer Software Support
Computer Technical Support
Construction-Construction and Building Inspection
Construction-Construction Management
Construction-Construction Supervision and Superintendency
Dental Assisting
Dental Hygiene
Dental Laboratory Technology
Early Childhood Education-Basic
Early Childhood Education-Family Day Care Provider/Foster
Care Provider/ In-Home Child Care Provider
Early Childhood Education-Master Teacher
Early Childhood Education-Site Supervisor
Early Childhood Education-Teacher
Electrical/Electronics Technology
Energy Systems - Photovoltaic
Energy Systems Solar Thermal
Engineering Technology
Civil Design Drafting Technology
Civil Drafting, CAD
Mechanical Design Drafting Technology
Mechanical Drafting, CAD
Foreign Language
French
German
Italian
Japanese
Mandarin Chinese
Russian
Spanish
Geographic Information Systems/Global Positioning System
Horticulture
Horticulture
Horticulture Foundations
Landscape Architecture and Design I
Landscape Construction
Landscape Construction and Management
Landscape Design
Landscape Maintenance
Hotel and Restaurant Management
Baking and Pastry
Culinary Arts
Restaurant Management
Intersegmental General Ed Transfer Curriculum-IGETC
Library Technology
Machine Technology
Medical Laboratory Technology
Music Industry Studies
Physical Education
Coaching
Fitness Instruction/Personal Training
Personal Training
Plumbing
Special Education Paraeducator/Instructional Assistant
Technical Theater
Women’s Services
Accomplishment
Administration of Justice-Community Relations Specialist
Administration of Justice-Correctional Specialist
Administration of Justice-Crime Scene Investigator
Administration of Justice-Criminal Law Specialist
Administration of Justice-Juvenile Counseling
Administration of Justice-Patrol Specialist
Art Digital Media-Foundation
Broadcast Communication Arts-Basic Digital Field Production
Broadcast Communication Arts-Basic Studio Production
Broadcast Communication Arts-Basic Writing for Digital Medium
Business
Bookkeeping Essentials
Business Essentials
Office Professional Essentials
Computer Aided Drafting & Digital Media for Engineering and
Architecture
Computer Information Systems-Database Management
Computer Information Systems-Project Management
Computer Information Systems-Web Graphics
Computer Information Systems-Web Technology
Computer Technical Support
Early Childhood Education-Associate Teacher
Early Childhood Education-Resource (Foster) Family Specialist
Geographic Information Systems/Global Positioning System
Music Industry Studies-Commercial Music
Plumbing