OFFICE OF THE REGISTRAR
Brown Hall, Suite 307
A
SSOCIATE
D
EGREE
A
PPLICATION FOR
D
IPLOMA
Student ID Number Date
Name Enrolled Under (Last, First, Middle, Other) Phone Number
Address (Street, City, Zip)
Student Signature
Intent to participate in August 10 Commencement Ceremony: YES NO
If you intend to participate, are you a first generation college student (Did either of your parents complete
a bachelor’s degree)? YES NO
If you intend to participate, please list a pronunciation for your name if it is typically mispronounced by a
native English speaker. Please separate syllables with dashes and indicate a STRESSED syllable with ALL CAPITAL
LETTERS. (Ex. Ravi Patel pronounced as RAH-vee pah-TELL)
NAME PRONUNCIATION:
This form is used to order your di
ploma. Diplomas are distributed prior to the commencement
ceremony. If you are unable to participate in the ceremony, the diploma will be mailed to the
address provided in approximately 6-8 weeks after the ceremony.
Please fill in the following information accurately and legibly.
PRINT YOUR NAME EXACTLY AS YOU WANT IT TO APPEAR ON YOUR DIPLOMA
:
(Upper and lower case letters please - no special characters)
You can submit this application for diploma by:
Mail—
Arkansas Tech University
Office of the Registrar
Brown Hall, Suite 307
105 West O Street
Russellville, AR 72801-2222
Fax—
479-968-068
3
Email—
graduation@atu.edu
Revised June 3, 2019
