Application for Graduation
Associate Degree and/or Certificate
Please complete this application with an Academic Adviser, Room A102. The adviser will complete the initial graduation audit of your academic
record. The following submission deadlines are applicable:
a) For May Graduates participating in the commencement ceremony, form must be received by March 1.
b) For May Graduates not participating in the ceremony, form must be received by May 1.
c) For August Graduates, form must be received by August 1.
d) For December Graduates, form must be received by December 1.
Please keep your contact information current with the records office until you receive your diploma.
1. Print your name exactly as you want it to appear on your diploma or certificate. Full legal name is customary. This is also the name that
will appear in the commencement program and announce you as you cross the commencement stage (if you participate).
2. Student ID #: _______________________________________Birthdate: ____________________________________________
Email Address: __________________________________________________________________________________________
3. Mailing Address: _________________________________________________________________________________________
City: _____________________________________________State: _____________________ Zip: _______________________
4. Home Phone: ______________________________________Cell Phone: ___________________________________________
5. List the catalog year and program of study that govern your graduation requirements (copy from your degree audit):
Catalog Year: ______________________________________Program of Study: ______________________________________
6. Please check the semester and indicate the year in which you expect to graduate. You must complete the degree
and/or certificate requirements before this date.
O May, ___________ (year); O August, ___________ (year); O December, __________ (year)
7. The college has one graduation ceremony each year, which is held in May. Degree recipients are eligible to attend. Please check one of
the following:
O Yes, I will participate in the May graduation ceremony.
O No, I will not participate in the May graduation ceremony.
8. If you checked yes to question 7, please complete the following information which will be used to order your cap and gown:
Height: ______________ feet , ______________ inches Weight: ______________ lbs
Note: Garb (approximately $25.00) must be purchased by all ceremony participants.
9. All graduates are customarily listed in the commencement program and in a newspaper announcement. If you do not want your name
printed in the program and included in the newspaper announcement, please initial: _________
By signing this application, I affirm that I have read and understand the college’s graduation requirements as set forth in the current college
catalog. In addition, I understand that this application will be used solely for the term indicated. If the final graduation evaluation determines that
I am not eligible for the degree and/or certificate in the term which I have indicated, I understand that I must file a new application in a future
term. I also understand that the ceremony will be videotaped for duplication and replay on cable television. I agree to the terms on the reverse of
this sheet.
Students Signature: _____________________________________________________________ Date: ______________________
1601 Washington Road | Westminster, MD 21157 |
Video Release and Authorization
I hereby consent for the Board of Trustees of Carroll Community College and its employees, volunteers, successors, and assigns (hereinafter
referred to as “the Board”) to record my picture and voice on photographs, films and audio and videotapes, to edit these recordings
at the discretion of the Board, and to incorporate these recordings into movie and sound films or audio and videotapes, webcast,
streaming, broadcasts (radio and television, including cable and satellite transmissions), programs, or otherwise, to use in any manner of
media whatsoever, including unrestricted use for purposes of publicity, advertising, and to use my name, likeness, or voice in connection
I hereby release the Board from any and all claims for damages for libel, slander, invasion of privacy or any other claim based on the use of
the above-described materials. I further waive any rights conferred under federal copyright laws or any other rights I might otherwise have
in the materials and the subsequent broadcast or commercial, educational, or other use by the Board. I understand that the recordings are
the exclusive property of the Board and the Board owns all rights to these recordings regardless of the form in which they are produced or
used. Further, I agree that I am not entitled to nor was I promised any compensation for the making of such recordings or their use.
I have read and understood the contents of this Release; wherefore, I have signed on the reverse side.