DACC Certificate Evaluation

DACC Certificate Evaluation

DACC Certificate Evaluation

Please print your name as you want it to appear on your certificate.


Name ________________________________________________  Date _______________
                                      Last                                       First                    Middle Initial
 
Student ID / Social Security Number ___________________________________________
 
Mailing Address:  ________________________________________________
                                      Street and/or Post Office Box
 
                           ________________________________________________
                                      City                     State                     Zip Code
 
Phone Number:    ________________________________________________
                                      Area Code   Number
 
Candidate for a Certificate in ________________________________________________
                                                                                Area of Study
 
Indicate the year your certificate will be completed:  _______________________________
 
Indicate month your Certificate will be completed:  ____December       ____May       ____July

For DACC Office Use Only

 

Counselor:  __________________________________ Date: _____________
Approved _____  Denied _____   
   
Division Chair:  _______________________________ Date: _____________
Approved _____  Denied _____   
   
Registrar:  ___________________________________ Date: _____________
Approved _____  Denied _____   
   
Comments: ________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________ 
GPA:  _____        H.S. Diploma/GED:  _____  
   
Original - Records Office           Yellow - Student Services

Upcoming Events