APPLICATION TO GRADUATE
Please print your name as you wish it to appear on your diploma.
(last name must be the same as listed in our student information system)
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Name
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Social Security Number or Student ID Today's Date
I plan to complete my degree/graduate in the:
[ ] Fall semester
[ ] Spring semester
[ ] Summer semester
Catalog Privilege: A student has the option of graduating under the requirements of the catalog in
effect at the time of initial enrollment, providing the student has maintained continuous enrollment and
all requirements are completed within five years of enrollment.
If you are not graduating under the current catalog, please state the catalog year that meets your program
and course requirements: ________________________________.
The student is responsible for paying and clearing debts, fees, or fines, etc., in order to be eligible for
graduation. In addition, the student must complete the graduate survey and all required graduation tests.
There is no graduation fee; however, you are responsible for ordering and paying for your own
black cap, tassel, and gown.
Attend the commencement ceremony as announced.
Students who do not attend the ceremony will need to make arrangements to pick up the diploma a week
after graduation or pay the Business Office an additional $8 fee for the diploma to be mailed to the home
address.
Look at the programs listed on the back of this sheet and place a check mark (√) next to the program(s) you
will graduate from this semester.
Check the program you will graduate from this semester:
CERTIFICATE OF PROFICIENCY:
[ ] Emergency Medical Technology [ ] Pipe Welding (SMAW-Stainless Steel)
[ ] Child Development [ ] Pipe Welding (SMAW)
[ ] SMAW Welding [ ] Pipe Welding (GTAW)
[ ] MIG Welding [ ] Pipe Welding (GMAW/FCAW)
[ ] TIG Welding [ ] Mechanical Devices
[ ] Medical Transcription [ ] Industrial Motors & Controls
[ ] Radio Broadcasting [ ] Fluid Power (Hydraulics & Pneumatics)
[ ] Brakes, Suspension & Steering [ ] Programmable Controls
[ ] Engine Performance [ ] Administrative Assistant
[ ] Auto Elec./Electronic Systems, Computerized Controls [ ] Accounting
[ ] Engine Repair & Climate Control [ ] Business Management
[ ] Drive Train Specialist [ ] Diesel Engines
[ ] Criminal Justice [ ] Diesel Brakes
[ ] Diesel Electrical/Electronics
[ ] Diesel Steering & Suspension
`TECHNICAL CERTIFICATE:
[ ] Practical Nursing [ ] Radio Broadcasting
[ ] General Studies [ ] Agriculture
[ ] Administrative Assistant [ ] Medical Assisting
[ ] Accounting [ ] Health Professions
[ ] Pipe Welding [ ] Welding
[ ] Criminal Justice [ ] Automotive Service Technology
[ ] Diesel Technology [ ] Industrial Technology
[ ] Cosmetology [ ] Industrial Electricity
[ ] Business Management [ ] General Studies
ASSOCIATE OF APPLIED SCIENCE DEGREE:
[ ] Accounting [ ] Nursing RN
[ ] Administrative Assistant
[ ] Business Management
[ ] General Technology [ ] Occupational Therapy Assistant
[ ] Physical Therapy Assistant
[ ] ASSOCIATE OF ARTS
[ ] ASSOCIATE OF GENERAL STUDIES
[ ] ASSOCIATE OF SCIENCE IN LIBERAL ARTS & SCIENCES: Communication
[ ] ASSOCIATE OF SCIENCE IN BUSINESS
ASSOCIATE OF SCIENCE IN AGRICULTURE
(choose one track):
[ ] Agri Business track
[ ] Agri Education track
[ ] Agriculture Science track
ASSOCIATE OF SCIENCE IN EDUCATION (choose one track):
[ ] K-6
th
[ ] 4
th
-8
th
(HSU transfer)
[ ] Middle Level Language/SS/Math/Science (UALR transfer)
[ ] ASSOCIATE OF SCIENCE: CRIMINAL JUSTICE
[ ] ASSOCIATE OF SCIENCE: PSYCHOLOGY
[ ] ASSOCIATE OF SCIENCE: MEDICAL SCIENCES
[ ] ASSOCIATE OF SCIENCE: STEM
[ ] ASSOCIATE OF SCIENCE: NATURAL RESOURCES
Rev. 2/3/20