FOR OFFICE USE ONLY:
EMAIL: ____________
SHADEGR: _________
SHADIPL: __________
FOR OFFICE USE ONLY PAID______ DATE: _______ INITIALS: _____
Newburgh Campus 1 Washington Center, Newburgh, NY 12550
Middletown Campus 115 South Street, Middletown, NY 10940
(845) 341-4030 ● registrar@sunyorange.edu
Graduation
Application
Last Update 10/3/2017
Please complete this form and return it to Student Services Central with the non-refundable $55.00 graduation fee.
If
not approved for graduation, the graduation fee will carry over to the next application.
Name: ___________________________________________________ Student ID: A ___ ___ ___ ___ ___ ___ ___ ___
Last First
Term/Year you expect to complete requirements for Graduation: Conferral Month: ______________ Year: ________
Degree Program: ___________________________________________________________________________________
Dual Degree?
(If Yes and you are completing two degrees in the same semester you must complete two separate graduation applications and pay the application
fee for
each
degree.)
Second Degree (if applicable):
(Circle YES ONLY if you have previously received a degree from SUNY Orange)
Do you plan to transfer additional credits from another college that has not already been received by SUNY Orange
to
complete your degree?
If yes, from which college(s) :_____________________________________________________________________________________________
*Please note you must file a “Permission to Attend Another Institution” form with the Registrar’s Office to be approved for transfer credit.
DIPLOMA INFORMATION
CLEARLY PRINT YOUR NAME EXACTLY AS YOU WISH FOR IT TO APPEAR ON YOUR DIPLOMA
First Name Middle Name or Initial Last Name
YOUR DIPLOMA WILL BE DELIVERED TO THE MAILING ADDRESS YOU PROVIDE BELOW:
(To ensure you receive your diploma/certificate you must notify the Registrar’s Office of any changes to your mailing address after you submit your
application registrar@sunyorange.edu)
Check if New Address
Address: _______________________________________City: _________________________ State: _______ZIP Code: ___________
Home Telephone: ________________________Cell Phone: _____________________ Email:_________________@sunyorange.edu
I understand that:
I am fully responsible for being familiar with and meeting the graduation requirements of my program and that final
certification requires a graduation audit completed by the Office of the Registrar
That if I do not meet the requirements for graduation by the semester indicated that I must re-apply for graduation
That an official transcript including any credit from another institution to be used for graduation purposes must be
submitted to the Registrar’s Office at least 7 days prior to my graduation date
That an overall 2.0 grade point average is required for all degrees and for an A.A.S. degree a 2.0 in major courses (either
cumulative or in each course) is required in addition to the overall 2.0 grade point average
I must settle all financial obligations to SUNY Orange and clear any student record holds before a diploma or certificate can
be received
Signature: __________________________________________________Date: ______________________
