Room 2220, West Campus
3300 Century Ave North
White Bear Lake, MN 55110
Century College is a Member of the Minnesota State Colleges and Universities system. We are an affirmative action, equal opportunity employer and educator. This document can be
available in alternative formats to individuals with disabilities by calling 651.779.3354 or 1.800.288.1978 x 3354
For Degree/Diploma and or Certificate
Star ID: OR Tech ID:
Your diploma name will be printed as it appears on your permanent student record. If you want a different student name printed on
your diploma, you must provide legal documentation of your name change to the Records Office. If you have a preferred name that has already
been submitted, please print below.
First Name Middle Name Last Name
Diploma Mailing Address: Your diploma will be mailed to you 4-8 weeks AFTER your degree has been posted to your transcript. It is your
responsibility to keep your address current and up-to-date. You may do so via eServices or submit a Change of Information form at the Records
Street Address Apt # City State Zip Code
Primary Phone Number: Alternate Phone:
Home Cell Work Home Cell Work
Email Address: @my.century.edu Personal Email:
PSEO ONLY** Please state your anticipated date of high school graduation:
If you are a law enforcement application, when do you plan to take the Post Exam?
Which TERM is your anticipated graduation? Fall Spring Summer Year:
Program #: Program/Major Name:
AA AFA AAS AS DIP CERT MNTC Only
Please choose your catalog/program guide year:
2018 – 2019 2017 – 2018 2016 – 2017 2015 – 2016 2014 – 2015 2013 – 2014
OTHER PROGRAM REQUIREMENTS (if applicable)
Transfer Credits (Are you transferring credits that will apply to this degree from another institution?)
NO. I do not have any transfer credits that apply to this degree program.
YES. My transfer credits are reflected in my degree audit (DARS).
YES. I will send official transcripts from the following schools or contact the DARS office (651.779.3908) to have my e-transcript pulled after
grades are posted.
ACADEMIC PETITIONS (Academic Petitions are not common.)
Have you filed an academic petition for a course substitution/waiver? NO YES
If YES, briefly explain what you petitioned:
Petition status (check one): Approved Pending; submitted date (approx.):