INSTRUCTIONS: Complete the section within the first bordered area below, and then carefully follow the
instructions on the back of this form.
Please PRINT
ID or SSN:
(Legal Name to Appear on the Diploma)
Home phone:
I am seeking a: (Click on one)
Work phone:
AA Degree AAS Degree
Applied Science Certificate
Occupational Certificate
Graduation term is
(Be specific about a concentration)
I will walk in the spring commencement ceremony.
I will not walk in the spring commencement ceremony.
Signature of Applicant
Certification by Faculty:
I certify that this student has met or, by the end of the appropriate term, will have met all course
and minimum grade requirements for this major.
Signature of Faculty Advisor
I certify that I have reviewed this Petition and have cleared any substitutions of courses necessary
to complete the coursework for this major. A record of substitutions is attached to this form.
Signature of Vice President of Academic Affairs
Financial Clearances:
Accounts Receivable Clearance:
Graduation Fee:
Receipt No.
Certification by the Office of Academic Services:
I certify that I have reviewed this Petition at the end of the term and have verified that all
requirements, academic and fiscal, have been met for graduation and I have, therefore, caused the
appropriate entry to be made to the student’s academic record.
________________________________ ____________ ___________ ________
Signature of Director of Academic Services Date Cum. GPA Honors
Office Use
_____ EX Entry _____ Final Audit
Instructions on the back of this form
mr JICS 0919
1. After completing the first bordered section on the opposite side, visit Student Affairs
where you will obtain an unofficial advisement copy of your transcript along with all
plans of study, and course substitution forms.
2. Take the transcript, plan of study, course substitution forms, and this form to your
assigned faculty advisor.
3. Your advisor will review your transcript against the requirements on the degree plan
and, if all course and GPA requirements have been met, will sign-off on the form. If
any exceptions or substitutions have been arranged, the approved course substitution
form for each course must be attached to this Application.
4. Take the Application and all corresponding documents to Student Affairs. Student
Affairs will forward the application and documents to the Vice President of Academic
Affairs for approval. The Vice President will review the packet and confirm or deny
any exceptions, which have been made by the faculty advisor. The Vice President
will initial any changes and sign at the appropriate place to indicate confirmation.
5. Pay the appropriate graduation fee to the cashier. The cashier will verify that you have
no outstanding debts to the College and will notify Student Affairs that the graduation
fee has been paid. If you are petitioning for your first certificate, there is not a charge
for the certificate. However, a graduation fee is assessed for academic regalia if you
plan to participate in the graduation ceremony.
6. The form will ultimately be forwarded to the Director of Academic Services for action.
The Director of Academic Services will conduct a final audit of the packet. If any
problems are identified, you will be contacted regarding any deficiencies.
7. At the end of the term, the Application will be double-checked for all grades, courses,
and GPA requirements. If all requirements are satisfied, a degree (or certificate) will
be issued.
Note: Candidates for graduation should petition prior to the deadline as published in the
institutional calendar. There is no guarantee that petitions received after this date will be
processed for the current semester. If the late petition is accepted, a late fee will apply.
mr JICS 0919