Petition to Graduate

Petition to Graduate

Section A. To be completed by Student in certify eligibility for Graduation
Student Name*

First NameLast Name
Student ID #*
What month and year do you graduate? *
Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Personal Email*
example@example.com
Type name as you wish it to appear on diploma/degree*
I have successfully completed all courses in my program*

Clear
Date*

MonthDayYear
Date

Section B. To be completed by Program Chair
Program
Hours/Credits Required to graduate.
minimum required to graduate (pre populated)
# Hours/Credits completed:
Within minimum time frame?

YesNo
CGPA:
minimum 2.0
LDA

MonthDayYear
Date
CPR card - Date obtained (if applicable)

MonthDayYear
Date
CPR card - Date obtained (if applicable)

MonthDayYear
Date
I confirm the student has met all graduation requirementsSignature

Clear
Date

MonthDayYear
Date

Section C. To be Completed by Registrar
Registrar Signature

Clear
Date

MonthDayYear
Date

Section D. To be completed by Financial Aid Department
Exit Counseling Completed on

MonthDayYear
Date
Date

MonthDayYear
Date
FA Signature

Clear

Section E. To be completed by Business Office
Balance
Student has satisfied financial obligation to school

YesNo
Payment plan established on

MonthDayYear
Date
Eligible for Official Transcript?

YesNo
Business Office Signature:

Clear
Date

MonthDayYear
Date

Section F. To be completed by Career Services
Select all that apply

Cover Letter & Resume submitted and approvedCompleted graduate job assistance application
Career Services Signature:

Clear
Date

MonthDayYear
Date
Should be Empty: