PL:rb 06/21/2018
Submit this form to:
Chabot College
Office of Admissions and Records
25555 Hesperian Boulevard
Hayward, California 94545
www.chabotcollege.edu/admissions
Fax: (510) 723-7510
GENERAL EDUCATION CERTIFICATION REQUEST
(CSU GE BREADTH OR IGETC)
STUDENT INFORMATION
STUDENT NAME (LAST, FIRST, MIDDLE) STUDENT ID NUMBER
STREET ADDRESS PHONE NUMBER
CITY, STATE, ZIP CODE E-MAIL ADDRESS
Check One:
CSU GE Breath
IGETC UC/CSU
Send To: Check One:
Ful
l Certification
Partial Certification
(IGETC Only)
Process:
Send Now
After grades posted for
_____________________
Semester/Year
READ CAREFULLY BEFORE SUBMITTING THIS FORM
1. Only one
eneral education (full or partial certification) will be sent to the school that you desi
nate.
2. Certifications are sent directly to the university. A copy is sent to the student.
3. There is no charge for this request.
4. Please see a counselor for preliminary review of your student record before submitting this request.
5. Partial certification is defined as completing all but two (2) courses on the IGETC pattern.
6. It is
the student’s responsibility to submit all official transcripts from colleges attended with coursework being a
pplied to
GE certification.
7. For UC Only: If you are using high school coursework to fulfill the Language Other Than English, please submit an
official transcript directly to Chabot College, Admissions & Records, 25555 Hesperian Blvd., Hayward, CA 94545.
8. AP Exam: If you are using an AP Exam to fulfill any areas of CSU GE Breadth or IGETC, please submit your official test
scores directly to Chabot College, Admissions & Records, 25555 Hesperian Blvd., Hayward, CA 94545.
9. If you complete all areas of CSU GE Breadth or IGETC, you will be awarded a Certificate of Achievement in CSU
Breadth or IGETC. This award will also reflect on your official Chabot College transcripts. Please indicate your name
below to appear on your certificate.
_________________________________________________________________________________________
First Name Middle Name Last Name
By signing below, I certify that the information submitted is accurate and I understand the information provided above.
Student Signature ______________________________________________________________ Date ___ / ___ / ___
OFFICE USE ONLY
Proc
essed By: _________________________
Notes:
Copy m
a
iled to student:
Full Certification sent:
Partial Certification sent:
___ / ___ / ___
___ / ___ / ___
___ / ___ / ___
