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Prerequisite Clearance Request
Instructions: Follow steps 1-4 and submit at least 3 to 4 weeks before your registration date. Check the
Assessment website at http://www
.deanza.edu/admissions/placement/prerequisites/ for exceptions to using this form.
STEP 1 Your Student Information
DATE: ___________ QTR: F W Sp Su YEAR: ________ STUDENT ID: _____________
STEP 2 De Anza College Course Information
List De Anza course(s) for which you are requesting prerequisite clearance. Example using EWRT 1C Literature
and Composition:
DEPT. EWRT COURSE NO. 1C TITLE Literature and Composition.
DEPT.________________ COURSE NO. __________ TITLE _________________________________
DEPT.________________ COURSE NO. __________ TITLE _________________________________
DEPT.________________ COURSE NO. __________ TITLE _________________________________
STEP 3 Proof of Prerequisite Coursework
Please check box if applicable. Otherwise, include both A and B as proof of completed coursework.
Completed at Foothill De Anza Transcript already submitted from _________________
(include college/university)
A. Catalog
description from
prior college for
course(s) that you
want considered for
prerequisite
clearance.
B. *College transcript with final grades for courses from prior colleges that you want
considered for prerequisite clearance. Include one of the following:
• If you plan to attend De Anza for two quarters or more, submit an Official
Transcript in a sealed envelope.
OR
• If you plan to attend De Anza for only one quarter, you may submit an Unofficial
Transcript.
*High school transcripts will NOT be considered for prerequisite clearance.
STEP 4 Submit for Review
Attach your completed Prerequisite Clearance Request form to your Proof of Prerequisite Coursework documents
and submit in one of the following ways. Note: The best way to submit a request with an unofficial transcript is
online by e-mail.
ON CAMPUS
If
Sealed&or&U nofficial&Transcript&!
Place&Documents&I n:!
PREREQUIS ITE!CLEARANCE !DROP!BOX!
Located!near!so uth!entrance!of!!
Student !and!Community!Services!Bu ildin g!&
OFF CAMPU
S
If
Sealed Transcript
Mail Documents To:
De Anza College
21250 Stevens Creek Blvd.
Cupertino, CA 95014
Attn: Assessment Office
If Unofficial Transcript
Attach ele
ctronic copy
of proof of coursework
and e-mail all documents to
daclearprereq@fhda.edu
Request cannot be processed until all documents are received. Allow 3 to 4 weeks. Rev. 11.05.15
AP Scores sent by College Board
NAME LAST: _____________________ FIRST: ______________________ MIDDLE: __________________
PHONE NUMBER: _______________________ EMAIL: ________________________________________
