Name: ___ _____ ____ Phone #: __ Student ID #:
Last First M. I.
Cerritos College strongly believes in the value of the matriculation process and that your chances of success at the
college are greater if you participate in the matriculation components; however, the college recognizes that students
may request exemption or exception from participating in matriculation services. Submit exemption or exception
requests to the Office of Admissions, Records & Services or fax to (562) 467-5068 and allow a processing time of
10 working days.
Components of Matriculation
The matriculation plan consists of several components provided by Cerritos College, which include:
AdmissionsProcedure for processing the admission application
AssessmentAdministration of assessment instruments for all non-exempt students to determine competency in
computational and language skills
OrientationPresentation of information concerning: college programs and services, policies and procedures, and student
rights and responsibilities
Counseling and AdvisementAdvisement concerning: course selection, selection of educational goals, development of
educational plans, student rights and responsibilities, and college policies and procedures
Student Follow-upPost-enrollment evaluation of academic progress with appropriate referrals as necessary
Coordination and TrainingFaculty and staff training with respect to the provision of matriculation services
Research and EvaluationInstitutional research for determining information about the student population and evaluating
efficacy of services, assessment instruments, impact and effectiveness of matriculation
Prerequisites, Corequisites, and AdvisoriesProcess for establishing, reviewing, and monitoring requisites or advisories
If you have questions about matriculation exemption or exception, please see a counselor. If you have special needs for
completing assessment, orientation or counseling, please contact the Assessment Center or the Counseling Department.
EXEMPTION from Matriculation Services
I am requesting exemption from (check all that apply):
Assessment Orientation and Counseling
I am requesting exemption based on:
I am enrolled full-time at another college/university OR have completed matriculation services or courses at a
regionally accredited community college/university (attach documentation: e.g., transcripts, test placements,
EAP scores, college letter verifying completion of orientation, etc.)
EXCEPTION from Matriculation Services
I am requesting exception from (check all that apply):
Assessment Orientation and Counseling
I am requesting exception because: ____________________________________________ ___
Note: Exempted or excepted students are still required to meet program and course prerequisites. A REQUISITE
CLEARANCE form must be submitted to the Office of Admissions, Records & Services to petition for these clearances.
I understand that the matriculation process at Cerritos College is designed to help me succeed in reaching my
educational goal(s). However, I release the Assessment and Counseling departments from the obligation of providing the
aforementioned matriculation services to me and claim full responsibility for my academic performance. I may, at a later
time, elect to participate in any matriculation services.
Student Signature: Date:
For A&R Office Use Only
ASM: Approved Denied Date entered: __________ Staff initials: _________
Term: ________ ORI: Approved Denied Date entered: __________ Staff initials: _________
Rev. 1/6/12
Student must be referred by a Faculty/ Staff member:
Department: __________________________________
Name: _______________________________________