PETITION FOR CERTIFICATE OF ACHIEVEMENT
NAME: STUDENT ID NUMBER
Type your name EXACTLY as you want it printed on your certificate
EMAIL: PHONE:
I hereby petition to receive a Certificate of Achievement in:
I followed the requirements as listed in the following catalog: (List catalog year)
CERTIFICATE OF ACHIEVEMENT REQUIREMENTS:
1. Complete major courses as outlined in the catalog for a program approved as a Certificate of Achievement.
2. A “C” grade or better is required in each course taken for the certificate, unless otherwise specified.
3. Petitions must be returned to ADMISSIONS & RECORDS by October 18, 2019 (Fall)
Petitions must be returned to ADMISSIONS & RECORDS by March 13, 2020 (Spring)
(Petitions received after deadline will be processed for the following semester.)
4. It is the responsibility of the Program Coordinator to certify that each applicant has met all of the certificate
requirements. The student must provide a copy of all transcripts for review with this form.
5. If a course is used from another college to meet a program requirement, that transcript must be on file and evaluated by
the Admissions & Records Office before the certificate is awarded.
COURSES AS LISTED IN THE CATALOG
Student’s Signature: ________________________________________________ Date: _____________
Program Coordinator’s Signature: ______________________________________ Date: _____________
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