Roster Certification Form

The Roster Certification Form shows the courses for the term for which you are the Instructor of Record. This form must be printed, signed, and submitted to the Admissions and Records Office, located in DeRicco Student Services Building, at the end of each semester or intersession. Along with this form, please submit any Incomplete Grade Forms and/or Academic Grade Change Forms. These can also be mailed to:

Admissions & Records
Attn: Rosters
5151 Pacific Avenue
Stockton, CA 95207

For any problems encountered with the completion of this form, please contact the Admissions & Records personnel:

Karen Sea
Phone: 954-5151 ext. 6127

Roster Submission Certification