Student M# _______________________ Social Security # __________________________
Last Name First Name M.I.
Local or Cell Phone Number Personal Email Address
________________________ (Check One):
Graduation Major / Curriculum Degree Certificate
Graduation Semester (Check One): _______
Spring Summer Fall Year
If you have not attended MVCC within the last year, please provide the semester last attended:
Your diploma will be printed with your name as it appears on your academic record. Your diploma will be
mailed to the permanent home address currently on file unless you indicate a different address below. Please
check here if you want your permanent home address changed to this one. _______
Street Address City State Zip Code
By completing this form, you are requesting that your Associate Dean review your record to determine if you
have completed the requirements necessary to graduate from the curriculum listed above. If you are not
certified to graduate in the term listed above, you will be required to complete a new form for the subsequent
semester to be considered a candidate.
Note – You must have completed at least 50% of the total credits in a certificate program or 70% in a degree
program to apply for graduation. If you anticipate graduating from more than one program, you must submit a
separate Graduation Review Request Form for each degree or certificate.
Submit this form to the MVCC Office of Records and Registration at least 60 days before your expected date of
graduation. Please allow 3 – 4 weeks after graduation for your degree to be posted to your record and an
additional 2 – 3 weeks to receive your diploma by mail.
Student Signature Today’s Date
Rec eived!By/Date!_ ___________________!
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