Revised 10/2019
This form must be completed with an Advisor. After submission of this application to the Office of the Registrar,
an official degree audit and review of curriculum requirements will occur to certify your eligibility for graduation.
My degree/certificate requirements will be complete:
Fall (January)
Priority application deadline is October 1.
Summer (August/September)
Priority application deadline is June 1.
Spring (May)
Priority application deadline is February 1.
I will be one course short of graduating in May.
I wish to participate in the May Commencement Ceremony. I will
complete all degree/certificate requirements. I understand I need to
submit this form by February 1 and a new Application to Graduate
after the requirements are complete.
Student ID#: _______________________________________
Student Legal Name: ________________________________
Date of Birth: ______________________________________
Phone Number: ____________________________________
Personal Email Address: _____________________________
Name for Diploma or Certificate: Print your name clearly and exactly as you want it to appear on your diploma/certificate. Please
indicate special characters, capitalization or accent marks to include in your diploma name.
Name: ___________________________________________________________________________________________________
First Middle Name or Initial Last
Address* to mail diploma (mailed 4-6 weeks after Commencement):
Street/PO Box: ____________________________________ City: _____________________________ State:________ Zip:_______
*This address will become your permanent mailing address on file with the College.
Degree or certificate applying for (separate applications must be submitted for more than one degree or certificate):
Associate in Arts (AA) Associate in Science (AS) Associate in Applied Science (AAS) Certificate (CT)
Program (required): _________________________________ Concentration (required): ___________________________________
Are you requesting to continue in another degree/certificate at CCCC after graduation?
No Yes
If yes, list program information. Degree: ________ Program: _____________________________ Concentration: _______________
Student Signature (required): _________________________________________________________ Date: __________________
I understand that all course, degree or certificate requirements must be complete and a minimum of 2.0 Grade Point Average
(GPA) must be met from my program of study in order to graduate.
With my signature above, I also authorize Cape Cod Community College to release information for the Commencement program, local newspapers and professional photographer. The College may also share mailing,
personal email and telephone contact information with the Cape Cod Community College Alumni Network, part of the Educational Foundation. If I do not want the release of this information, I will submit a Request to
Withhold Directory Information form with this application. (Placing a FERPA hold on Directory Information will prevent release of information permanently until revoked within context of State and Federal law and/or in
writing by the student.)
Academic Advisor Use:
Number of credits the student has earned toward degree/certificate program: __________
Number of credits the student needs to complete degree/certificate program: __________
Does the student have an overall GPA of 2.00 or greater prior to the end of the current semester?
No Yes
Does the student have any outstanding CLEP, Course Challenge, Substitutions or Transfer Credit, or need re-evaluation of
current transfer credits to be evaluated?
No Yes If yes, note details:
Advisor Signature (required): ___________________________________________________ Date: _________________________
Advisor Printed Name (required): ________________________________________________________ Extension: ____________
Office of the Registrar APPLICATION TO GRADUATE
2240 Iyannough Road West Barnstable, MA 02668
774.330.4711 Fax: 508.375.4084