Valley College
San Bernardino
Application
for
Degree
and/or
Certificate
Please complete the requested information completely. Applications that are incomplete cannot be
processed. Return completed applications to the Records Office in the Administration Building. I you
have any questions concerning your educational plan and/or your academic progress toward the
Associates Degree or Certificate, please make an appointment with the Counseling Office (909-384-4404)
BEFORE submitting this form.
Petition submitted for year 20___
r
Fall (Deadline Oct. 1st)
r
Spring (Deadline March 1st)
r
Summer (Deadline July 1st)
When this deadline falls on a Saturday or a Sunday, the ling period will be extended to the following Monday.
_______________________________________________________________________________________________
Degree and/or Certicate sought (You must le a separate petition for each degree and/or Certicate sought):
r Associate in Arts Degree Major ___________________________
r Associate in Science Degree Major ___________________________
r Certicate of Achievement Major ___________________________
Student Information - Please PRINT
Please answer YES or NO to the following:
NAME __________________________________________________ STUDENT ID# __________________
LAST FIRST
ADDRESS _______________________________________________________________________________
NUMBER-STREET CITY STATE ZIP
PRIMARY TELEPHONE ___________________ ALTERNATE TELEPHONE _____________________
OTHER NAMES USED AT SBVC ______________________ DATE OF BIRTH ____________________
STUDENT EMAIL _______________________________________________________________________
_____ If you are applying for a degree, do you have a graduation check? If yes, attach a copy. If no, please make an
appointment with a counselor before submitting this application.
_____ Have you attended SBVC prior to 1981? If so, when? ___________________________
_____HaveyoupreviouslyappliedforanAssociateDegreeorCerticateatSBVC?Ifso,when?________________
_____ Have you petitioned to have courses waived or to substitute a course? If yes, attach documentation.
YOUR PETITION CANNOT BE PROCESSED UNLESS ALL DOCUMENTATION IS ATTACHED
u Response to this petition will be sent to your SBVC email account t
No
No
No
No
Wyoming
FOR ASSOCIATE DEGREE CANDIDATES ONLY
Please indicate the catalog year and the graduation plan you are following. If you are unsure, please contact
the Counseling Ofce for assistance.
Option 1 r A. IGETC (Intersegmental General Education Transfer Curriculum)
r UC r CSU
r B. CSUGE (CSU General Education Breadth Requirements)
Option 2 r General Associate Degree
r Associate in Science
r Associate in Arts
Catalog Year ___________________
FOR CERTIFICATE CANDIDATES ONLY
r Waivers or substitutions have been used. Please attach verication and/or documentation of any waivers or
course substitutions granted. Waivers and/or substitutions are granted by the Department or Division.
_________ Catalog Year. Course requirements are specic to a catalog year. Any catalog may be specied as
long as your enrollment has been continuous, as dened by the College Catalog.
u Response to this petition will be sent to your SBVC email account t
List all other colleges you have attended where you have completed courses that will be used to fulll SBVC
graduation requirements. You must have ofcial transcripts sent directly from each college listed before an
evaluation can be completed. To verify that transcripts have been received, contact the Records Ofce at (909)
384-4401.
__________________________________________ __________________________________________
__________________________________________ __________________________________________
__________________________________________ __________________________________________
Student Signature ________________________________________________ Date ______________________
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