Online Dropout Prevention Specialist Certificate Program

Application Instructions

Please note: * (asterisk) Indicates a required field.

Applicant Information

Personal information included on this form will be kept confidential in order to protect against unauthorized disclosure.

Name:

(Maiden Name, Previous Name)

(mm/dd/yyyy)

Address:
Phone:
Are you an international student:

Voluntary Student Demographic Information

The College of Continuing Education at Sacramento State is committed to providing equal opportunity in education. A critical element of our commitment to diversity lies in our ability to collect and assess student demographic data. Your response to the voluntary student demographic information would be very helpful and much appreciated

Academics & Experience

 

Academic Preparation Add More

Please list all post-secondary institutions from which you have been granted degrees/certificates/credentials and from which you have taken relevant coursework.

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Experience Add More

Work and/or Educational Experience

(200 characters left)

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Additional Information

Participation in, or successful completion of, the Dropout Prevention Specialist certificate program does not confer any national or state credential or licensure and is not a guarantee of employment.

I certify:

I certify under penalty of perjury that I have provided complete and accurate responses to the items listed on this application. I further certify that all official documents submitted in support of this application are authentic and unaltered records that pertain to me. I have read and agree to comply with the statements listed above. 

Application Fee:

An application fee of $30 will be collected after eligibility has been determined. You cannot be enrolled into the program until the application fee has been collected.

Privacy Policy:

The College of Continuing Education respects your right to privacy. Any information given to us when requesting course or program material will be used solely for the purpose of answering or responding to your request. We do not sell or otherwise distribute your personal information. We may, however, use it to provide you with advanced notices of our course offerings. If at any time you wish to be removed from our mailing lists, you may contact us and your request will be processed immediately.

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