GRADUATION CONTRACT – Baccalaureate Degree
After completing this form and obtaining the appropriate signatures, return it to the Records & Advisement Office
PERSONAL INFORMATION – Please print clearly
Name_______________________________ I.D. #______________________
Local Phone # Cell Phone__________________
E-Mail Address____________________________________________________
Major(s) 1.__________________________2.____________________________
Minor(s) 1.__________________________2.____________________________
Degree(s) Catalog Year_________________
YOUR DIPLOMA NAME: Print your name exactly as you want it to appear on
your diploma. Use upper and lower case letters and accent marks (if applicable).
_________________________________________________________________
First Middle Last Suffix
I plan to graduate in (please check the box & indicate the year):
❑ December ❑ May__________
I will be present at the graduation ceremony:* ❑ Yes ❑ No
*If you will be present at the ceremony, you must order regalia at www.cbgrad.com
ACADEMIC INFORMATION – For Student and Adviser
Student: By checking these boxes, I acknowledge that I am responsible for meeting ALL
graduation requirements as stated in the university catalog.
Adviser: By checking these boxes, I confirm that the student has completed the following
graduation requirements.
Yes
Yes
124 hours total (or more, depending on major)
Yes
Yes
Three Service Level 1 & 2, Two Service Level 2 or 3
(not required for catalog years prior to 2011-2012)
Yes
Yes
Major upper division hours (BS: 18, BA: 14);
Minor upper division hours: 6
Yes
Yes
Cumulative and Southern GPA of 2.0 (refer to
school/dept. for major GPA)
ETS Proficiency Profile (Senior Exit Exam - required)
Yes
Yes
Major field achievement test (if required)
Certification (if applicable) – To be completed by Certification Officer
SDA State Certification None (no signature required)
Certification Officer’s Signature _____________________________ Date __________
SENIOR CLASS SCHEDULE – Are you taking any classes off campus?* ❑ Yes ❑ No If yes, which semester(s)? ❑ Fall ❑ Winter ❑ Summer
Course # & Title Fall Sem./Year__________ Credits Course # & Title Winter Sem./Year__________ Credits Course # & Title Summer Session/Year__________ Credits
Total Hours_________
*Home Study/Off-Campus Course Title College/University
Total Hours_________ Total Hours_________ Total Hours_________
By signing this contract, all parties confirm the information is correct to the best of their knowledge. Any changes must be approved by the Adviser AND the Asst.
Director of Records & Advisement, and will require submission of a new contract.
Student:_____________________________ Date:________ Adviser:____________________________ Date:_________ Asst. Dir. of Records:________________________ Date:_________
