Fillable GRADUATION DATE REQUEST FOR CHANGE OF (California State University, Dominguez Hills)

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GRADUATION DATE REQUEST FOR CHANGE OF (California State University, Dominguez Hills)

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Last Updated: September 12, 2018
DATE RECEIVED IN A&R
Cashier’s Stamp Document
Processing fees received:
TO BE COMPLETED BY STUDENT: (Please Print) STUDENT ID NUMBER: _______________________
LAST NAME: ___________________ FIRST NAME: ___________________ PHONE: ________________________
ADDRESS: ____________________________________ CITY: _____________ STATE: _____ ZIP CODE: _________
FORMER GRADUATION DATE (Please insert year): Fall 20 ________ Spring 20 _____ Summer 20 ____
NEW GRADUATION DATE (Please insert year): Fall 20 ________ Spring 20 _____ Summer 20 ____
_______________________________________________________________
Student’s Signature Date
I approve the above named student’s request to change their graduation term to the term indicated above.
____________________________________________________________________________________ _____________________
Major Advisor’s Name (Please Print) Major Advisor’s Signature Date
____________________________________________________________________________________ _____________________
Minor Advisor’s Name (Please Print) Minor Advisor’s Signature Date
REQUEST FOR CHANGE OF
GRADUATION DATE
Office of Admissions and Records (WH 290)
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GRADUATION DATE REQUEST FOR CHANGE OF (California State University, Dominguez Hills)

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Completed 18 August 2020

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