GRADUATION CEREMONY 2020
S
TUDENT REGISTRATION & REGALIA ORDER FORM
PERSONAL INFORMATION
__________________________________________________________ _________________________
Student Name (exactly as you want it to appear in the grad program) Student ID Number
__________________________________________________________ _________________________
Addr
ess Birth Date
__________________________________________________________ _________________________
City Province Postal Code Telephone Number
Country of Ci
tizenship: _______________________________________
PROGRAM INFORMATION
Program: __________________________________________________________________________________
Certificate Diploma Associate Degree Degree
Height: ____’ ____”
Regular size gown (44” chest & 60” body) or Full fit gown
(45”+ chest & 74” body)
Do you have a physical disability that will require extra assistance during the ceremony? Yes
No
If Yes, we will contact you directly regarding your needs.
Do you intend to wear traditional cultural garments/accouterments to the ceremony?
Yes
No
AGREEMENT
By signing below you accept full responsibility for the rental and return of the regalia. Additional charges may be applied
for unreturned or damaged gowns. In addition, by signing you agree to allow your graduation photo to be used for
promotional purposes. In the event I am unable to pick up my regalia, I authorize _______________ to pick it up on my behalf.
__________________________________________________________ _________________________
Signature Date
FEES
Please n
ote that Registration Fees for Graduation are non-refundable.
Graduation Fee: $20.00 Cash Cheque Credit Card***
To register for your graduation ceremony, please visit Student Services. Payment may be made in person at any campus
with cash, debit card, cheque or credit card, or by mail with cheque only. To help prevent credit card fraud DO NOT write
your credit card information anywhere on this form.
DEADLINE TO REGISTER IS APRIL 30, 2020
Mixalakwila (Port Hardy) Port Alberni
Campbell River
Please check which ceremony location you will be attending:
Comox Valley
