Revised 11-4-14
Admissions & Records
2700 E Leland Rd. Pittsburg, CA 94565
925.473.7500, fax 925.427.6351
IGETC/CSU GE CERTIFICATION REQUEST
________________________________________________________________________ ________________________________________________
Print Name: Last, First, Middle Student ID#
________________________________________________________________________ ________________________________________________
Other Names Used at LMC Birthdate
________________________________________________________
Phone#
Are you currently enrolled in IGETC/CSU GE courses? Yes
No – If so, which term? Spring Summer Fall
In Progress requests are sent within 4 business weeks after end of term.
Will coursework from another college be used? Yes No
Please ensure official transcripts are on file.
For IGETC certification to a UC, was the foreign language requirement completed in high school?
Please ensure official transcripts are on file. Yes No
Are you applying AP Test scores? Yes No
Please ensure official scores are submitted.
Are you requesting partial certification? Yes No
See note below.
An evaluation will not be completed until all official transcripts are on file with the Los Medanos College Admissions & Records Office. List ALL institutions where
coursework was completed applicable to the IGETC or CSU GE.
1. ______________________________________________________________ 2. _____________________________________________________________
3.______________________________________________________________ 4. _____________________________________________________________
Send Request to: (University Name and Address-IGETC Certifications can only be sent directly to the College and/or University)
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
NOTE: Los Medanos College may grant a partial certification of IGETC to students who are missing no more than two requirements. Please consult with a
counselor to determine which universities accept partial IGETC certifications and what the guidelines are for completing the missing requirements.
If your CSU GE or IGETC pattern is complete, you may be eligible to receive a certificate of achievement. Should you file during
the spring term after the certificate filing deadline, your name will not be included in the commencement program. Earning a
certificate may affect financial aid eligibility in the future. Please check with the Financial Aid office regarding eligibility. Please fill
out all information completely and legibly to ensure accurate processing. Shortly after your certification is evaluated, you will
receive a status letter with additional information.
Print your name as you would like it to appear on your certificate.
__________________________________________________________________________________________________________________
I choose to not receive the certificate of achievement.
Signature:_________________________________________________________________________Date:_____________________________________
Select One:
IGETC
CSU GE
