First Name
________________________________________Middle Name
______________________________________
Last
Name ________________________________________ Social Security Number______________________________
Current Street Address_________________________________________________ City________________________ State_______________________ Zip________________________
Current
Phone Number ___________________________________
Name of Advisor _________________________________________
| PRINT NAME AS IT IS TO APPEAR ON DIPLOMA | |
| First name: | |
| Middle name: | |
| Last name: | |
| MAILING ADDRESS FOR DIPLOMA | |
| Street/PO Box: | |
| City: | |
| County: | |
| State: | |
| Zip: | |
| Degree | 1st Major Code | 2nd Major Code | Minor Code |
| Bachelor of Arts | |||
| Bachelor of Science | |||
| B.S. in Business Adm. | |||
| B.S. in Education | |||
| Bach. of Gen. Studies | |||
| Associate of Arts | |||
| Associate of Science |
Anticipated Completion Date (date all requirements will be completed)
| May | _______(year) | Attending Ceremony? Yes or No / If yes - Height______ Weight _____ |
| July | _______(year) | July grads will participate in May Commencement Ceremonies |
| Dec | _______(year) |
Conditions:
I understand and agree to the following:
1. That this application must be completed by October 25 or May graduates and April 25 for December graduates.
2. If this application is not completed by the above dates, I accept full responsibility that I may not have adequate time to informed of and fulfill all requirements for the chosen graduation date.
3. If seeking double degree or double major, this application must bear signature of each department concerned.
Signed _________________________________________ Date ________________________
Approval:(this section will be completed after the application is received in the Registrar's Office.)