CHABOT COLLEGE REQUEST FOR AAAS DEGREE OR CERTIFICATE PLEASE

							                                                                                   CHABOT COLLEGE
_________________________________________________________               REQUEST FOR AA/AS DEGREE OR CERTIFICATE
 NAME     Last             First              Middle
                                                                          PLEASE COMPLETE ONE REQUEST FORM
_________________________________________________________                   FOR EACH DEGREE OR CERTIFICATE
 ADDRESS               Number and Street                             AA/AS candidates: Please list all college/universities* attended:
_________________________________________________________            ____________________________ From ___/ ___ to ___/___
                              City, State, Zip
_______________________________                                      ____________________________ From ___/ ___ to ___/___
STUDENT ID NUMBER (REqUIRED)
                                                                     ____________________________ From ___/ ___ to ___/___
I attended Chabot College from ___ / ___ to ___ / ___
I plan to complete/have completed all of my requirements:              *Please note: Official transcripts must be on file from the colleges
Fall/Spring/Summer        Year ______                                  and universities attended. If you need more space see the reverse
YOU MUST COMPLETE 30 UNITS AND ONE SEMESTER AT CHABOT                  side. Associate Degree Evaluations will only be started after all
COLLEGE TO REQUEST AN EVALUATION FOR AN AA/AS DEGREE.                  transcripts have been received.

                  CLEARLY PRINT YOUR NAME AS YOU WANT IT TO APPEAR ON YOUR DIPLOMA/CERTIFICATE:

                              First                      Middle                    Last
                     UNCLEAR PRINTING wILL PRODUCE A MISSPELLED NAME. REPRINT CHARGE IS $20.00
PLEASE CONSULT THE CHABOT COLLEGE CATALOG FOR NAMES OF           If the address you listed above is different than the address on file
DEGREE MAJORS AND CERTIFICATE TITLES. CHECK ONE ONLY:            with Chabot College, please complete a Personal Data Change
 ___ Associate in Arts Major: ___________________________        form. An Associate degree requires 60 degree applicable semester
           (For Liberal Arts, list either Option I, II or III)   units.
                                                                 All evaluations are done in writing.
 ___ Associate in Science Major: ________________________        Please allow 8-12 weeks for a response.
                                                                 All holds must be cleared before evaluation can be completed.
 ___ Certificate of Completion Title: ______________________     If you do not complete the requirements in the current academic
                                                                 year, you must reapply.
 ___ Certificate of Achievement Title: _____________________
                                                                 Student Signature: _____________________________________
 ___ Certificate Title: __________________________________
                                                                 Date: _______________________________________________