Chadron State College Application For Graduation - Bachelor’s Degree
Signatures and $20 Fee (payable at the Business Office) Required
GRADUATE INFORMATION
Graduation Date: May ______ August ______ December ______ E-Mail Address______________________________
(year) (year) (year)
Name: __________________________________________________ Student ID Number: ________________________
(As you wish it to appear on your diploma)
Local Address: ______________________________________________________________________________________
St, Rt, Box City, State, Zip Telephone
Address to Mail Diploma: ______________________________________________________________________________
St, Rt, Box City, State, Zip Telephone
City, state and country you wish to have listed on the commencement program:
_________________________________
PROGRAM INFORMATION – PLEASE COMPLETE ONLY ONE:
BACHELOR OF SCIENCE IN EDUCATION
ELEMENTARY – Minor(s)/Endorsement(s): SECONDARY – Endorsement(s)
(Please Specify Field/Subject)
____________________________________________ _________________________________________________
Year of Catalog:_______________________________ Page Number of Program(s): _________________________
BACHELOR OF ARTS OR BACHELOR OF SCIENCE NON-TEACHING (Please circle one)
Major(s): _____________________________________ Minor(s): _________________________________________
_____________________________________________ _________________________________________________
Year of Catalog: _______________________________ Page Number of Program(s): _________________________
If you are enrolled in correspondence study or courses at other institutions, please list courses and institutions:
__________________________________________________________________________________________________
Verification of enrollment at other institutions must be received at the Registrar’s Office by the application deadline.
We must receive a transcript with a grade for correspondence study thirty (30) days prior to graduation.
SIGNATURES REQUIRED:
I understand that I must have completed or be enrolled in all requirements for my degree prior to the graduation
application deadline. If not, I will attach a letter stating the reason(s). I understand that any graduation
correspondence will be done through my Eagle mail account.
_____________________________________________ _________________________________________________
Student Signature Date
_____________________________________________ _________________________________________________
Financial Aid Academic Advisor(s)
_____________________________________________ __________________________________________
Academic Dean Business Office Receipt #
PLEASE RETURN THE COMPLETED APPLICATION, INCLUDING SIGNATURES, ALONG WITH YOUR FEE RECEIPT TO THE
REGISTRAR’S OFFICE BY THE APPLICATION DEADLINE.
Revised 7/09
