Application for Graduation
REMINDER: THIS APPLICATION IS DUE BY MARCH 17, 2021!
Students who wish to receive a diploma for completion of degree or certificate must apply for graduation. All
candidates must complete this form and submit it to firstname.lastname@example.org BEFORE March 17, 2021.
1. Student ID Number:________________ Birth date:____/____/____ SS# _______-______-_______
2. Name: _____________________________________________________________________________
4. Phone (Home): (______) ______-___________________ (Cell): (_____) ______-___________________
5. E-Mail: ______________________________________________________
6. Please print your name exactly how you wish it to appear on your diploma/certificate:
7. Are you currently enrolled? Yes No
8. Semester/Year of Program Completion: Fall/Dec 2020 Spring/May 2021 Summer/August 2021
9. Are you a New Jersey STAR? Yes No Are you a member of any honor society?
Are you an EOF recipient? Yes No Check all that apply: PTK
Are you a US Veteran? Yes No MAT NJCBAA SCE
10. Degree: A.A. A.S. A.A.S. A.F.A. Certificate
11. Are you going to attend the commencement ceremony on Saturday, May 22, 2021?
YES - Your cap and gown will be ordered for you. Pick-up
information will be shared when it becomes available. The
following information will be used to order your cap and gown:
If you or your guests will require accommodations (example: sign language interpreter), please contact
disabilities services at 908-835-2300 at least three weeks prior to graduation day.
NO - Your diploma/certificate will be available for pick up from the Office of Student Service after
fulfillment of all academic and financial obligations. You will be emailed when it is ready for pick up.
STUDENT SIGNATURE: X_______________________________________ DATE:____________________
1. To apply for graduation:
1. Sign the completed application by typing your name in the Student Signature field and add the date.
2. Save the form.
3. Attach the completed, signed application to an email addressed to email@example.com.
(First, Middle, Last)
City, State Zip Code