APPLICATION FOR GRADUATION / REQUEST FOR DIPLOMA**
Canisius College - Office of Student Records – Bagen 106
Please PRINT your name exactly as you want it to appear on your diploma.
Use upper & lower case letters & include any accent marks or punctuation.
(Changes to name/diploma reprints after order has been placed will result in a $30 fee.)
(First) (Middle) (Last)
If you feel it is necessary, please write your name phonetically on the line below.
This will assist the Dean in reading your name at the Commencement Exercises.
(Street) (City) (State) (Zip Code)
MAJOR DEGREE EXPECTED
Ex: Biology) (Ex: BA; BS; MS; MSED; MBA)
I will complete my degree requirements in: (Check one of the following)
May 20 (My diploma will be available at Commencement.)
August 20 (My diploma will be available approximately September 15th.)
December 20 (My diploma will be available approximately February 1st.)
UNDERGRADUATE students must submit this form to the Student Records Office (Bagen 106). It is
your responsibility to submit this request form to the Student Records Office by the dates listed below.
GRADUATE students must submit this form to their program office. It is your responsibility to submit
this request to your program office by the dates listed below.
Please make sure you understand the following deadlines.
If this diploma request is not submitted by the appropriate deadline,
your diploma will not be available until the next issue date.
If your requirements This Diploma Request Your Diploma
are completed: is due by: will be available:
IN MAY DECEMBER 15
AT MAY COMMENCEMENT
IN AUGUST AUGUST 1
APPROX. SEPTEMBER 15
IN DECEMBER DECEMBER 1
APPROX. FEBRUARY 1
**This form authorizes Canisius College to publish your name in our graduation program.
Please notify us if you do not want your name to appear in the program.