Fillable Petition for Certificate of Performance (San Diego Miramar College)

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Petition for Certificate of Performance (San Diego Miramar College)

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The Petition for Certificate of Performance (San Diego Miramar College) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

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San Diego Community College District
Petition for Certificate of Performance
City Mesa Miramar
• Only coursework completed in the San Diego Community College District may be used to complete certificate
requirements.
• No waivers of course requirements will be allowed.
• Students must achieve a grade of “C” or better in each of the required courses.
• Certificate requirements must be met prior
to submitting this form.
Name: Date:
(PRINT) Last First MI
Student ID Number: Ethnicity (see reverse):
Address:
Street City State Zip
E-mail: Telephone:
Title of Certificate:
I completed my requirements at the end of the (semester): of (year):
OFFICIAL USE ONLY
Certificate Completed: Student Notified:
Date Initial Date Initial
Certificate Picked Up:
Student Signature Date
UNABLE TO PROCESS, SEE REVERSE
Distribute: College Evaluations; copy sent to Department
SS – PETCRTPRFRM 10/2017
Ethnicity (Select all that apply):
Asian Indian
Asian Other
American Indian/Alaskan Native
Black or African American
Cambodian
Chinese
Filipino
Guamanian
Hawaiian
Hispanic
Japanese
Korean
Laotian
Latino
Pacific Islander Other
Samoan
Vietnamese
White
OFFICIAL USE ONLY
Your request for a Certificate of Performance is being returned by the College Evaluations Office for the following
reason:
Certificate requirements are not complete. Re-submit this request when all requirements have been met.
Other:
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Petition for Certificate of Performance (San Diego Miramar College)

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Completed 25 July 2020

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