PETITION TO GRADUATE
Select the semester you plan on graduating.
Fall _________ Spring _________ Summer (If semester is held)
I am requesting that the Office of the Registrar review my academic record to determine whether I am
eligible to graduate.
A00000__________________________
Student Haskell ID # Student Name (Please print)
Current Campus Box or Local Address, City, State, & Zip
Degree (AA, AS, BA, BS): _________ Major: ___________________________
Emphasis (if applicable):_______________________
Advisor: _______________________
Have you applied for a four-year program? Yes No
Are you already accepted into a four-year program? Yes No
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I understand by submitting this petition into the Office of the Registrar that I could graduate with my degree. I
understand that if I am graduating with an associate’s degree that I have applied for a four-year program. If I am not
accepted into the four-year program, I will not be eligible to return to Haskell upon graduation.
!
_____________________________________ _____________________________________
Student Signature Advisor Signature
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Graduation Diploma Information
The diploma will be ready in 4-6 weeks after final exams. Mail my diploma to the following address after my
graduation eligibility has been certified and diploma printed.
____________________________________
____________________________________
____________________________________
Telephone #: _________________________ My e-mail address is:
How my name should appear on the diploma:
Graduation Ceremony
___ NO, I do not plan to participate in the graduation ceremony.
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___ YES, I would like to participate in the graduation ceremony.
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This form must be signed by the graduation candidate and advisor and filed with the Office of the
Registrar by the deadline posted on academic calendar.
