Admissions & Records
College of the Siskiyous, 800 College Ave., Weed, CA 96094
Phone: (530) 938-5500 - Fax: (530) 938-5367 Email:
Petition to Graduate / Certificate
Student Information
Name (Name in COS system will appear on Transcripts/diploma):
Maiden Name/Other Names:
Student ID#: S00 Date of Birth:
COS Email: Phone:
Current Mailing Address:
City: State: Zip Code:
Address to Mail Diploma to (if different):
City: State: Zip Code:
Semester (check one): Fall Spring Winter Summer
Associate Degree with Major in:
Associate Degree for Transfer with Major in:
Certificate of Achievement in:
Certificate in:
*Do you plan to use prior coursework from another college? Yes No
*Official transcripts with final grades must be on file to count toward degree.
Commencement Information (For Associate Degree petitioners only)
Do you plan to participate in the May graduation ceremony? Yes No
Are you a Veteran student? Yes No
Do you need accommodations? Yes No
Your name will appear in the commencement program and media release unless you change your information to confidential.
For Office Use Only
Degree Approved: Yes No Within 3 Units Registrar approval
GPA: Honors High Honors Degree posted
Comments Degree mailed
For Counseling Use Only