3000 Campus Hill Drive, Livermore CA 94551 Admissions & Records Office
Fax (925) 606-6437 Email: lpc-evaluations@laspositascollege.edu
Anticipated Completion: Spring Summer Fall
*Last Name, First Name, Middle Initial (Preferred or Legal Name)
*
Your name and permanent address will be updated on the College's student information system to reflect the current information provided
on t
hi
s f
orm. Y
our s
i
gnature i
s confirmation that the above information is valid.
My Preferred or Legal Name should appear as follows on my diploma/certificate:
Preferred Legal Name Last Name, First Name, Middle Initial
My Preferred or Legal name
should appear in the commencement program:
Preferred Legal Name Last Name, First Name, Middle Initial
PLEASE READ CAREFULLY AND CHECK BEFORE SIGNING BELOW:
I understand that I will be awarded the Certificate of Accomplishment upon successful completion of required courses with a grade point average
of 2.00 or higher. Completion of the required program must be completed at least fifty percent (50%) at Las Positas College, including the last three
(3) units.
I have submitted official transcripts from ALL other previously attended regionally accredited post-secondary institutions, Advanced Placement
(AP)/International Baccalaureate (IB), and College-Level Examination Program (CLEP), if applicable.
The Certificate of Accomplishment will not appear on your transcript. It will be printed on an official College stationary by Admissions and Records
Office. Honors designations will not be assigned on Certificate of Accomplishment. Students will not be invited to participate in the
Commencement Ceremony.
If my previous major does not match with my requested certificate, I understand and allow LPC Admissions and Records Office to change my major
and home campus.
If I do not complete my requirements in the current academic semester, I must reapply.
REQUEST FOR CERTIFICATE OF ACCOMPLISHMENT
Business Mass Communications
Bookkeeping (0587) Mass Communications: Radio Communications (0614)
Business Workforce Proficiency (0588)
Occupational Safety and Health
Computer Information Systems Occupational Safety (1090)
Project Management (0784)
Web Development (0785)
Emergency Medical Services
Emergency Medical Responder (1232)
Student signature:
Date:
By signing above, I certify that my request form is complete and accurate to the best of my knowledge.
Submit this form either of the following: Admissions and Records Office, Building 1600, 2nd Floor
Mailing address: Admissions and Records Office, Las Positas College, 3000 Campus Hill Drive, Livermore, CA 94551
Email: lpc-evaluations@laspositascollege.edu Fax: (925) 606-6437
STAFF USE ONLY
Evaluator signature: Date:
Approved Denied
Request for Cert of Accomplishment CC
TW/js 09/2019
