PETITION FOR CERTIFICATE OF ACCOMPLISHMENT

AND/OR

11460 Warner Avenue SPECIALIZATION

Fountain Valley, CA 92708-2597

FILING DATES: SUMMER: June 13-July 15, 2016

FALL: August 29-November 14, 2016

SPRING: February 1-April 4, 2016

Please fill out all information completely and return to the Admissions office by the final date above.

PRINT YOUR NAME AS YOU WISH IT TO APPEAR ON YOUR CERTIFICATE.

Name______

First Middle last

Address______

Number Street City/State Zip Code

Student ID#______email: ______

Indicate which Certificate you are requesting at this time: ______

Certificates of Specialization Certificates of Accomplishment

Advanced Accounting Cisco Certified Networking Administrator (CCNA)

Intermediate Accounting Comp TIA

Biotechnology Media Design Cyber Security

Business Plan Digital Media

Cisco Certified Networking Professional (CCNP) Animation & Gaming Foundation Cognitive & Caregivers Boot Camp Educational Studies

Home Business General Office Assistant

Homeland Security TSA Human Services

MCSA: Windows 8 Leadership

MCSA: Windows Server 2012 Medicate Administrative Office Technician

Real Estate Lending & Mortgage Brokering Medical Coding Specialist

Real Estate Property Salesperson Mobile Applications

Process Technician Fundamentals

Project Management

Windows Server 2008

ALL official transcripts from other educational institutions must be on file at the time you submit your petition. (The petition will be denied if transcripts are not on file.) If you are not currently enrolled you will need to meet the current catalog degree requirement for the current academic year.

List college(s) you have attended that will apply toward your certificate (if applicable):

______; ______;

In the box below list the course(s) you are currently enrolled in (include “credit by exam” of applicable).

Course Number & Name / Units / Course Number & Name / Units

Please note: Certificates will not be noted on student’s transcripts.