SCE State Certificate Request Form

Thank you for your interest in the School of Continuing Education. Complete the following form and someone will contact you shortly.

* First Name:

* Last Name:

* Student ID:

* Current Address:

* City:

* Zip Code:

* Phone Number:

(xxx-xxx-xxxx)

Email:

(Must conform to email format)

* Select program/certificate earned (Please refer to the letter received from the Graduation Office)

English as a Second Language (ESL)
Career Education (CE)
GED/HiSET
Adult Basic Education (ABE)

* Site Attended:

CEC SAC SACJ OCCT

* Print your name below EXACTLY as you wish it to appear on your certificate..

Note: The above name will appear on your certificate

Enter the address you would like your certificate sent to:

Address

City

Zip Code

Sites:

CEC = Centennial Education Center
SAC = The Adult Education Center @ Santa Ana College
OCCT = Orange County Children's Theater
SACJ = Santa Ana College Jail/Inmate Program