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
• 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.
(PRINT) Last First MI
Student ID Number: Ethnicity (see reverse):
Street City State Zip
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