Request form for the Service Learning Certificate of Completion, Graduation Cord and Stole

Your Service Learning request will be processed by the Service Learning Office in 1-2 weeks. You will be notified via email.

Students who complete at least 15 hours of Service Learning per class in a single semester may fill out this form to request a Certificate of Completion for their dedication to Service Learning. Students can also complete this form to request a graduation stole and cord. Students will need to complete 100 or more hours for their entire time at Palomar College to earn the graduation stole. Students will need to complete 50 or more hours for their entire time at Palomar College to earn the graduation cord. Students will be notified via email once their service hours are verified. Students will be able to pick up their certificate at our office or have it mailed/emailed to the appropriate location. The certificate is free. In 2024, we received a generous donation Foundation Grant to provide the graduation stole and cord for free. Limited supply.

Student Information
Name*
First Last
Student ID*
Email*
Phone
Please indicate what you requesting*
- Service Learning Certificate (Free)
- Service Learning Graduation Cord ($10 – Paid by a Foundation Grant))
- Service Learning Graduation Stole ($15 – Paid by a Foundation Grant))
Service Learning Completed
Name the professor(s) you completed service learning hours with
Name the course(s) you completed service learning hours*
(example: CHDV 115, ASL 216)
Semester(s)*
(example: Spring 2023)
Name of Organization(s)*
Hours Completed*
must have completed a minimum of 15 hours to be eligible for a certificate, 50 hours to be eligible for the graduation cord, and 100 hours to be eligible for the graduation stole.
Please write a short essay about your experience. How did you contribute to the organization? What did you learn from this experience? (relate to course material learned in class) What did grow personally from this experience (what did you learn about your self?*
Essay should be at least 200 words yet not exceed 600 words
Do you give permission to the Service Learning Department to use quotes from your essay to use on the website, in printed materials, and in presentations to show the impact of Service Learning?*
- Yes, and you may use my name
- Yes, but please don’t use my name
- No
Thank you for requesting your Service Learning Certificate of Completion, Graduation Cord and/or Stole
We will reach out to you once your hours are verified. Thank you for your hard work and dedication to Service Learning!