Revised January 11, 2019
OFFICE OF THE REGISTRAR
Brown Hall, Suite 307
U
NDERGRADUATE
A
PPLICATION FOR
G
RADUATION
Student ID Number
T
Date
Name Enrolled Under (Last, First, Middle, Other) Phone Number
Student Signature
This form is used to order your diploma; you will purchase your cap and gown at the Bookstore.
Please fill in the following information accurately and legibly.
PRINT YOUR NAME EXACTLY AS YOU WANT IT TO APPEAR ON YOUR DIPLOMA
:
(Upper and lower case letters please - no special characters)
In order to help ensure your name is pronounced correctly during graduation, please list a pronunciation for your name
if it is typically mispronounced by a native English speaker. Please separate syllables with dashes and indicate a STRESSED
syllable with ALL CAPITAL LETTERS. (Ex. Ravi Patel pronounced as RAH-vee pah-TELL)
NAME
PRONUNCIATION:
Pronunciation
Recorded:
Are you a first generation college student?
*A first generation college student is an individual both of whose parents did not complete a
baccalaureate degree.
Please check the term below that your degree requirements will be completed:
S
rin
Summer Fall
ear:
Catalog: Major: Minor:
Catalog: Major: Minor:
Catalog: Major: Minor:
*If you are seeking two Bachelor’s degrees (Double Degree),
please indicate which major you’d like to walk with in the ceremony: _________________________
Y
ou can submit this application for graduation by:
Mail—
Arkansas Tech University
Office of the Registrar
Brown Hall, Suite 307
105 West O Street
Russellville, AR 72801-2222
Fax—
479-968-0683
Email—
graduation@atu.edu
Yes No
