Fillable APPLICATION LATE GRADUATION Office of Admissions and Records (California State University, Dominguez Hills)

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APPLICATION LATE GRADUATION Office of Admissions and Records (California State University, Dominguez Hills)

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The APPLICATION LATE GRADUATION Office of Admissions and Records (California State University, Dominguez Hills) form is 1 page long and contains:

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  • 12 check-boxes
  • 22 other fields

Country of origin: US
File type: PDF

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DATE RECEIVED IN A&R
Date Stamp and Initial
Cashier’s Stamp Document
Processing fees received:
This form is only accepted if applying beyond the published LATE deadline for your term.
Directions:
1-Complete this form. □
2-Complete the Petition for Exception form with the necessary documentation. Approval is not guaranteed. □
3-Pay the appropriate processing fees to the Cashier’s Office. □
4-Submit this complete packet to Admissions and Records, WH-C290. □
Anticipated Date of Graduation (Please indicate one only):
Term:
Year: ____________
STUDENT ID:
DATE OF BIRTH:
LEGAL NAME as it appears on your CSUDH records (Please also provide previous names, if any)
Last Name
First Name
DIPLOMA NAME as you wish it to appear on your diploma (Last name must be the same as on your CSUDH record, or you will need
to file a Name/Address Change Request form with the Office of Admissions and Records.)
Last Name
First Name
MAILING ADDRESS FOR
DIPLOMA:
ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER:
EMAIL:
I understand that any changes made to the plan to complete requirements as approved by the advisor may result in a change of
graduation date.
_______________________________________________________________________ __________________________
Student Signature Date
DEGREE OBJECTIVE: BA □ BS □ MA □ MS □ MBA □ MPA □ MAT□ Certificate (List) □
MAJOR:____________________________________________________________________________________________
Concentration /Option (If Applicable)
Advisor Name & Signature: ___________________________________________________ Date:____________________
Major Program/Faculty Advisor Signature
2ndMAJOR:_________________________________________________________________________________________
Concentration /Option (If Applicable)
Advisor Name & Signature: ___________________________________________________ Date:_____________________
Major Program/Faculty Advisor Signature
MINOR:____________________ Advisor Name & Signature: ____________________________ Date: ________________
Minor Program/Faculty Advisor Signature
GENERAL EDUCATION COMPLETED (University Advising Center Signature) _________________________________
LATE GRADUATION
APPLICATION
Office of Admissions and Records (WH 290)
Last Updated: March 23, 2020
Please email the completed form with required signatures to graduation@csudh.edu by the appropriate deadline
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APPLICATION LATE GRADUATION Office of Admissions and Records (California State University, Dominguez Hills)

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Completed 18 August 2020

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