Peralta Community College District
Petition for AA/AS Degree or Certificate

Peralta Admissions and Records
333 E. 8 th Street
Oakland, Ca . 94606
(510) 466-7387


Complete this form, print (using your browser), sign, date the form, make an appointment with a counselor to review your petition, get his/her signature then mail (US mail) to the address above.
Full Legal Name:
(Last, First, Middle Init) 		,
Social Sec. #: - -
College you are petitioning?
I hereby petition for:
Major or Certificate name:
My graduation/certificate requirements were or will be completed at the end of
Other Colleges Attended:

Official Transcripts from all Colleges and Universities at which you completed units toward this degree/certificate must be on file in the Peralta District Admissions and Records office prior to filing this petition. If transcripts are not currently on file, they much be attached to this petition in a sealed envelope from the institution. It is not necessary to submit transcripts for courses taken at Alameda, Laney, Merritt or Vista Colleges.

Counselor assistance in reviewing for completion of the degree or certificate requirements is required but does not guarantee that all requirements for the degree or certificate have been met.

Student was seen by Counselor signature:_______________________ on date: ____________

and is completing requirements as stated in the College:_____________________ year: ________ catalog.

I would like my name to appear on the degree/certificate as follows:
Name: (First Middle Last)
Address
City: State: Zip:
Daytime (area code) & phone #
Birth Date: Mo: Day: Year:
Previous Name (if any):
Date of any previous petition submitted (if applicable) 

_______________________________________________
Student signature               Date
revised 1/26/99