Revised 08/12/2019
2019-2020 DUE BY FRIDAY MARCH 20, 2020 2019-2020
Black Hawk College
Application for Degree or Certificate Award
Use Blue or Black Ink Only.
This form should be submitted to the Enrollment Services Office immediately after you register for the final FALL or SPRING
semester in which you will be completing your graduation requirements. Students must clear all financial obligations before degree-
posted transcripts and the diploma will be mailed. We will send your degree audit information to your myBlackHawk email only.
PDF Instructions: Complete the form and save it to your desktop. Then, attach it to an email and send to registrar@bhc.edu.
Address for diploma mailing:
Phone: myBlackHawk Email:
Hometown (if different from address): Personal Email:
COMMENCEMENT CEREMONY PARTICIPATION - $20.00
❑ I DO ❑ I DO NOT
Plan to attend the ceremony at 7:00 pm on:
❑Wednesday, May 13, 2020 for QC Campus, or
❑Friday, May 15, 2020 for East Campus.
If attending, please indicate your height and weight below, and a cap and
gown will be ordered for you to pick up the week of the commencement
ceremony. There is a non-refundable fee of $20 ceremony participation.
Height _____________ Weight __________
CHECK DEGREE/CERTIFICATE
Check ONLY one – use a separate application for each award.
❑ Associate in Arts Degree (AA)
❑ Associate in Science Degree (AS)
❑ Associate in Fine Arts (AFA)
❑ Associate in Liberal Studies (ALS)
Requires specified Degree plan - see ALS advisor
❑ Associate in Applied Science - Career-oriented Degree (AAS)
List program_______________________
❑ Associate in Applied Science - (GOTS)
General Occupational & Technical Studies-See Advisor for Planning Sheet
❑ Certificate (CERT)
List Major________________________
By signing this document, I understand that selecting to participate in the commencement ceremony means that my account will be
charged $20.00, which is non-refundable once gowns are ordered, and that payment is due in order to obtain my final degree or
certificate. I understand my name will not appear in the ceremony program if this application is turned in after March 20, 2020.
Diplomas are mailed within 8 weeks after end of the term.
______________________________________________ ______________________________
Student Signature Date
Expected date of completion (check one)
❑ Fall 2019 ❑ Spring 2020 ❑ Summer 2020
List all other colleges attended:
______________________________________
_____________________________________
Did you attend BHC before Spring 1992?
❑ Yes ❑ No
Organizations Recognized in the
Commencement Program
Check the organization(s) of which you are a
member. If your membership status changes
after submitting this application, it is YOUR
responsibility to contact Enrollment Services
to ensure that it is included in the program.
❑ Academic All-American
❑ All-USA Community College Academic
Team Nominee
❑ Alpha Beta Gamma
❑ Black Hawk HONORS Program Graduate
❑ Distinguished Academic All-American
❑ Psi Beta
❑ Phi Theta Kappa
❑ Sigma Kappa Delta
❑ Veteran or currently serving in military
**Please PRINT your name the way you want it to appear on your diploma.
click to sign
signature
click to edit
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