Web Design Certificate Application Form

Please turn in application only if you have completed the program.


Students: This certificate application is a record of your achievement. Like a grade report, it provides documentation for the certificate award. When you complete all requirements sign and mail to:

Extension Certificate Program Office,
College of Extended & International Education
California State University, Dominguez Hills
1000 E. Victoria St.
Carson, CA, 90747

If you are receiving tuition reimbursement, copy this form after each course and submit it with your tuition fee receipt to your company reimbursement administrator.

Student Information

[Name as it should appear on the printed Certificate]

[Include Street Address, City, State and Zip Code]

Course Information

Required CoursesSemester Completed
1 Elective Course (one of the following)

Student Signature