Appendix L-2

For a usable version of this form, please download the PDF of the UF Contract from our website, and print this form.

CONTRA COSTA COMMUNITY COLLEGE DISTRICT

Credential Information

 

REQUEST TO GOVERNING BOARD TO ADD A MINOR FIELD

 

 

Type or Print

 

Name: ______________________________________________________________________________

Last                              First                                          Initial

 

Social Security Number: __________________________    Minor: __________________________

 

Department: _________________________________________________________________________

 

College(s): __________________________________________________________________________

 

Type of credential: ____________________________________________________________________

 

Expiration date: ______________________________________________________________________

 

Majors (subject matter) listed on credential:

 

____________________________________________________________________________

 

____________________________________________________________________________

 

Limitations specified on credential:

 

____________________________________________________________________________

 

____________________________________________________________________________

 

Minors listed on credential (asterisk those added by Contra Costa Community College District Governing Board):

____________________________________________________________________________

 

____________________________________________________________________________

 

Restrictions to minor:

 

□          Requires annual Governing Board approval

 

□          Other:  ______________________________________________________________

 

_______________________________________________________________

 

 

Courses used in Request to Governing Board to Add a Minor Field to Credential (see reverse side of page)

 

 

(24 units, of which at least 12 are upper division or graduate)

Institution

Date Completed

Course Number and Title

Units

LD.  U.D.-Grad.

 

 

 

 

 

 

 

 

 

 

                                                                        _________________________          ________________

College FSA Review Team or             Date

 

_________________________          ________________

President/Dean                                                Date

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