_______________________________ _______________________ __________ ______________________
______________________________________________ __________________________________________
Health Information Management
Associate in Science Degree
Career-Oriented Program
Deadline to Apply:
GRADUATION CHECKLIST Graduation Year: 20_______
Fall: December 1
st
2019-2020 Year of Catalog being used___________
Spring/Summer: April 15
th
__________________________________________________________________ @_____________________
NAME (First Name, Middle Initial/Name is optional, Last Name) BANNER ID
STREET ADDRESS TOWN ZIP PHONE#
Please note: All graduation correspondence will be sent to your college assigned email.
Please be advised that your name and academic major will be printed in the commencement brochure and your
academic major will be announced at the graduation ceremony if you choose to attend. Please notify the Enrollment
Services Office if you do not wish your information to be printed or announced.
Other college transfer credits to be used? Yes
• No •
From which college? _________________________________________________________________________________
Are they on file at MxCC? Yes
• No •
Are you applying for more than one degree? Yes
••No •
If yes, which curriculum? _____________________________________________________________________________
Graduation Requirements:
Have been met
• Will be met at the end of: Fall semester • Spring Semester • Summer Semester •
Minimum Required GPA for Graduation is 2.0 Current GPA: ___________
ADVISOR’S SIGNATURE* & DATE STUDENT’S SIGNATURE* & DATE
*Typed name is acceptable for signature.
Electronic Submissions: This form must be submitted to MX-Registrar@mxcc.edu from student’s official
college email address.
