Date   _______________________             Semester Graduation Requirements Completed_____________________________

Bmpftcc.bmp (476314 bytes)
Application for Graduation

SECTION I. To be completed by the student.  (Turn in the ENTIRE application with your $25 fee payment.)

INSTRUCTIONS: Please PRINT clearly, listing your name exactly as you want it to appear on your degree, diploma, or certificate. Do not complete sections II and III. If you are graduating from more than one curriculum, PLEASE COMPLETE A SEPARATE APPLICATION FOR EACH DEGREE, DIPLOMA, OR CERTIFICATE.

Exact name of curriculum ________________________________________________________________________________
Is this a degree, diploma, or certificate ________________________ Who is your advisor? _____________________________
Please print your name below exactly as you want it to appear on your degree, diploma, or certificate:

First Name

 . . . . . . . . . . . . . . . . . . . . . . . . . . .

Middle Name

 . . . . . . . . . . . . . . . . . . . . . . . . . . .

Last Name

 . . . . . . . . . . . . . . . . . . . . . . . . . . .

SSN __________________________________________  Telephone Number _____________________________________
Address______________________________________________________________
         _______________________________________________________________
                                                                            (Include city, state, and zip)

If you plan to attend graduation, please list your height and weight--

Height  __________________________                         Weight   _________________________
The following information is needed for reporting purposes; however, it is voluntary:

Are you employed? _____Yes _____ No             Job Title______________________________________________________
Name of Employer   ____________________________________________________City, State _______________________
Are you _____active duty military    _____ an active duty military family member    _____ military retiree    _____ civil service?
Which branch of service _____ Army        _____ Air Force        _____ Marine      _____ National Guard       _____ Reserves
_____________________________________________________________________
SECTION II. To be completed by your advisor.
Is the above-named student eligible to graduate with the degree, diploma, or certificate listed?
_____ Yes    _____ No              Major GPA ______________         _____Highest Honors             _____ Honors
If not please state reason ________________________________________________________________________________
Has the student been notified of ineligibility? __________________________________________________________________

_______________________________                                                                               ____________________________
Signature of the Advisor                                                                                                      Date
_____________________________________________________________________
SECTION III. To be completed by the Department Chairperson

___________________________________________________________       Confirmed  ___________________________
Signature of the Department Chairperson                                                                              Date