California Community Colleges System Office
1102 Q Street, Suite 300
Sacramento, CA95814 / Noncredit Application Continued, Page 2

NONCREDIT COURSE APPLICATION

(FORM CCC-456)

DATE:

A. TYPE OF APPLICATION

B. CONTACT INFORMATION

College: ------City -- 195346East – 195217Harbor – 195365Mission – 195953Pierce – 195384Southwest – 195387Trade – 195390 / District: Los Angeles
College Address:
Contact Person: / Contact Person's Title:
Phone Number: Ext. / E-mail Address:
Fax Number:

C. COURSE INFORMATION

1. Course Title: / 2. Course Dept. No.

(subject abbreviation & number)

3. Local Approval Dates:

a. Date Approved by Curriculum Committee / b. Date Approved by Governing Board:
4. Course Start Date / 5. Total Hours ofInstruction: / If variable hours, indicate the range of hours:
(Minimum to maximum)
6. Taxonomy of Program Code No: / . / 6a. Dual Taxonomy of Program Code / .
7. Course-SAM-Priority Code No:
8. Noncredit Eligibility Category Code
8a Dual Noncredit Eligibility Category Code
9. Material Fees
/ 10Special Characteristics Code Descriptor (check all boxes that apply)
Learning Assistance
Bilingual Education
Convalescent Setting
Correctional Facility
Apprenticeship
Persons with Substantial Disabilities
Citizenship for Immigrants

11. Justification: (What evidence of need for this course exists?)

12. Proposed Catalog Description:

13. Proposed Class Schedule Description:

14. Program/Certificate Title
14a. Program TOP Code: / 14b. Program Confirmation #:, If applicable

14c. This course complies with and is part of, the following Title 5 regulations, (check all that apply)

§55151 – Certificate of Completion

§55151 – Certificate of Competency

§55152 – Short-term Vocational Program providing 228 hours or more of instruction

§55153 – Other Noncredit Program providing 228 hour or more of instruction

§55154 – Adult High School Diploma Program

§55155 – Non-enhanced funded Noncredit Program providing less that’s 299 hour

§8150-8156 – Apprenticeship

Not part of a program

15. SIGNATURES We certify this course meets with the standards of Title 5, Section 55002(c)(1) & (2) and

Section 55002 (a) (1) noncredit category, and has been approved through the local curriculum procedure for thiscollege.

Chief Instructional Officer / College Curriculum Chair
Typed Name / Date / Typed Name / Date
Chief Executive Officer / Superintendent or Chancellor (Multi-Campus Districts)
Typed Name / Date / Typed Name / Date

Form CCC-456

Revised: March 2008