Graduation Date
Year:   Semester: Fall Spring Summer

Name (as it will appear on diploma):

Student ID Number

Degree
Associate of Arts      Associate of Science      Bachelor of Arts      Bachelor of Science      Master of Science

Major (for Bachelor of Arts, Bachelor of Science, and Master of Science degrees)
Select... Accounting Biology Business Administration Community Counseling Criminal Justice Early Childhood Education Humanities Interdisciplinary Studies Nursing Medical Technology Middle Grades Education Psychology Rehabilitation Counseling Secondary Grades Education Social Science Social Work Teacher Education

Mailing Address
Street   City   State   Zip Code

Phone (including area code)

E-mail Address

IMPORTANT: By clicking the Submit button, I acknowledge that this is a formal request for graduation. I understand an audit of my requirements for graduation will be conducted and if for any reason I do not meet the requirements for graduation, I am still responsible for paying the graduation fee with no refund. I further understand if I do not meet the requirements for graduation, I must re-apply the following year and will be responsible for any increase in graduation fees. I understand that if I do not wish to participate in the graduation ceremony, I must submit IN WRITING to the Academic Dean my intent, but I will still be responsible for paying all graduation fees.