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I intend to complete my degree: (select only (Louisiana Tech University)

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File type: PDF

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Revised 9/18/2018
BARKSDALE PROGRAM
Application for Graduation
I intend to complete my degree: (select only one)
□ Fall 20 □ Winter 20 □ Spring 20 □ Summer 20
Please type all information. Handwritten applications will no longer be accepted.
STUDENT INFORMATION
CWID:
Tech E-Mail:
Permanent E-Mail:
Check one of the following:
□ Officer □ Enlisted □ Retired □ Dependent □ Civilian
NAME EXACTLY AS IT SHOULD APPEAR ON DIPLOMA
First Name:
Middle Name:
Last Name:
STUDENT CONTACT INFORMATION (after graduation)
Address:
City:
Zip:
Home Town (City/State or COUNTRY) for Commencement Program:
Current Phone #:
Permanent Phone #:
ACADEMIC PROGRAM INFORMATION
(If you are receiving two degrees or if you are a double major, you must complete two separate applications)
Degree:
Major:
Minor:
Concentration:
List all current course you are taking:
Will you need assistance at graduation? Check one: □ Yes □ No
Will you attend the Commencement Ceremony? Check one: □ Yes □ No
DEGREE CANDIDATE’S SIGNATURE DATE
Pending completion of this term’s coursework, this student is eligible for conferral of the degree listed above.
________________________
________________________
________________________
_____________________________________________________
ADVISOR
_____________________________________________________
DEPARTMENT HEAD
_____________________________________________________
DEAN OF COLLEGE
DATE
DATE
DATE
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Completed 23 July 2020

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