3000 Campus Hill Drive, Livermore CA 94551 Admissions & Records Office
Fax (925) 606-6437 Email: lpc-evaluations@laspositascollege.edu
Anticipated Completion: Spring Summer Fall
*Last Name, First Name, Middle Initial (Preferred or Legal Name)
*Your name and permanent address will be updated on the College's student information system to reflect the current information provided on this form. Your
signature is confirmation that the above information is valid.
Indicate which of the following you are requesting for. Please refer to the College catalog or counselor for degree and/or certificate majors.
Degree/Certificate
Example: AAT
Major Title
Example: Anthropology (IGETC CSU)
My Preferred or Legal Name should appear as follows on my diploma/certificate: Preferred Legal Name
Last Name, First Name, Middle Initial
My Preferred name should appear in the commencement program: Preferred Legal Name
Last Name, First Name, Middle Initial
PLEASE READ CAREFULLY AND CHECK BEFORE SIGNING BELOW:
I understand that I will be awarded a degree and/or certificate if I have completed all requirements.
I have submitted official transcripts from All other previously attended regionally accredited post-secondary institutions, Advanced
Placement (AP)/International Baccalaureate (IB), College-Level Examination Program (CLEP), and/or course substitutions or waivers
are on-file, if applicable.
Veterans only: DD-214 on-file and verified by Veterans Specialist or designee.
I understand that I will be awarded a Certificate of Achievement in CSU GE Breadth or IGETC CSU, if I have completed all
requirements for an Associate Degree for Transfer.
If my previous major does not match with my requested degree or certificate, I understand and allow LPC Admissions & Records
Office to change my major and home campus.
If I do not complete my requirements in the current academic semester, I must reapply.
Student signature:
By signing above, I certify that my request form is complete and accurate to the best of my knowledge.
Date:
Submit this form either of the following: Admissions and Records Office, Building 1600, 2
nd
Floor
Mailing address: Las Positas College, Admissions and Records Office, 3000 Campus Hill Drive, Livermore, CA 94551
Email: lpc-evaluations@laspositascollege.edu Fax: (925) 606-6437
REQUEST FOR DEGREE OR CERTIFICATE
STAFF USE ONLY
Evaluator signature: Date: SHADEGR BDMS DD-214 Verified
Degree/Certificate Awarded: With Highest Honors (GPA 3.50 to 4.00) With Honors (GPA 3.25 to 3.49)
Re
quirements not met/Denied Need to re-apply
Request for Degree Cert 2019-2020Rev
TW/js 09/2019
Major Code
Example:
2240
Catalog Year
(if applicable)
