Office Use Only: SACP SGRD UACF
Counselor Signature (required): Date:
Petition for Skills
Attainment Certificate
Student ID# Birth Date Semester of completion Year
(see catalog for deadline dates)
I wish my name to appear on my certificate as follows:
Last Name First Middle
I wish to apply for a Skills Attainment Certificate for
Title of Skills Attainment Certificate &9"$5-: as it appears in the catalog
Catalog year I am following:
My mailing address:
Street Address/P.O. Box City State Zip Code
Permanent e-mail address: Phone:
(Include area code)
In order to have this application evaluated, I understand it is MY RESPONSIBILITY to have official transcripts from ALL
colleges on file at Columbia College. I certify that the information contained in this application is true and accurate to the
best of my knowledge.
Using other transcripts – please list:
SignatureSFRVJSFE: Date:
Complete form and return to:
Columbia College, Admissions & Records
11600 Columbia College Drive
Sonora, CA 95370
Fax (209) 588-5337
OTC Letter Eval. Prelim. Eligible
Mail Cert. Date: Eval. Final Ineligible
CC A&R 3/18/15 JN
Not valid without counselor signature
Not valid without student signature
