Application Form
For certification, please fill out the application form and mail or deliver to Ms. Gloria Pimentel, Department of Sociology, Chance Academic Center, Room #303E, San Antonio College, San Antonio, Texas 78666. If you have met all requirements, you will be awarded a certificate of recognition. Please allow at least one month for processing. For further information, you may email: gpimentel@mail.accd.edu, or call (210) 785-6073.
Student’s Name: ________________________________________________________________________
Social Security No.: ________________________________________________________________________
Address: ________________________________________________________________________
Phone Number: ________________________________________Email: ___________________________
Date of Application: _______________________________________
Requirements: You must have acquired 12 credit hours.
3 Credit Hours: You must have taken one of the following three courses. Place a checkmark on the course, indicating the section, year and semester it was taken:
9 Credit Hours
You must have enrolled in three courses designating “The Mexican-American Experience.” A complete listing of the courses is located on the website for your reference:
Please provide the following information:
Signature: ___________________________
__________________________________________________________________________________________________
Office Use Only:
Approved:_______________________________
Date:____________________