MIDDLESEX COMMUNITY COLLEGE
Deadline to Apply: GRADUATION CHECKLIST Graduation Year: 20_______
Fall: December 1
st
2019-2020 Year of Catalog being used___________
Spring/Summer: April 15
th
Health Information Management Certificate
__________________________________________________________________ @_____________________
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.
