PAYMENTS
It is the student’s responsibility to order regalia directly from the university bookstore located on the Melbourne campus.
For additional information, contact the bookstore at 321-674-8042 or visit http://t.bkstore.com.
Attach PROGRAM PLAN (graduate) or
PROGRAM OF STUDY (doctoral).
PETITION TO GRADUATE
o FIRST PETITION o RE-PETITION (originally petitioned for _________________________ term)
CAMPUS ________________________________________________ STUDENT ID NO. ____________________________________ DATE __________________________________________
NOTE: Candidate’s name will be printed on the diploma as it appears in the Florida Tech academic record.
NAME________________________________________________________________________________________________________________________________________
Last First Middle
LOCAL MAILING ADDRESS _______________________________________________________________________________________________________________________
Street/Apt. No. City State ZIP
LOCAL TELEPHONE __________________________________ HOME TELEPHONE _________________________________ WORK TELEPHONE __________________________________
I AM PETITIONING FOR GRADUATION AT THE END OF _____________________________________ . University Catalog year ____________________________ applies for major.
Fall, Spring, Summer/Year
I EXPECT TO COMPLETE THE REQUIREMENTS FOR THE (Check one)
o AA o AS o BA o BS o EdS o MA o MAT o MBA o MEd o MPA o MS o MSA o AvD o DBA o PhD o PsyD o GCP/UCP*
*Certicate programs do not participate in commencement ceremony.
DEGREE/GCP IN ________________________________________ ___________________ ________________________________________________________________
Major/Title Major/GCP Code Academic Major Advisor/O-Campus Site Representative Signature Date
___________________________________ __________________ _________________________________________________________________
Minor/Title Minor/UCP Code Academic Minor/Undergraduate Certicate Advisor Signature Date
_____________________________________________________________________________
Student Signature** Date
**By signing this petition form, I agree to my name, degree awarded and honors information appearing in all public graduation lists.
Please mail my diploma to the following address (if dierent from that shown above):
____________________________________________________________________________________________________________________________________________
Street/Apt. No. City State ZIP Country
Degree-seeking candidates only (excluding graduate certicates):
Check one o I will participate in Melbourne campus commencement exercises:
o I will participate at the o-campus site listed at the top of this form.
o I will NOT participate in the commencement exercises.
DOCTORAL STUDENT PREVIOUS DEGREES (Required):
Undergraduate
_______________________________________________________ _____________________________________________________________________
Name of Degree and Major Name of School, State/Country where earned
Graduate ____________________________________________________________ _____________________________________________________________________
Name of Degree and Major Name of School, State/Country where earned
Florida Institute of Technology § Oce of the Registrar § 150 West University Boulevard, Melbourne, FL 32901-6975
Education Center Students: Contact Your Site Director § Melbourne Campus Students: 321-674-8115 § Fax 321-674-7827
RGR-456-0220
GRADUATION OFFICE USE ONLY
SHADEGR _________ SHADIPL __________ SHACATT __________
Late Fee _______________Paid-Date ___________________________________ Receipt No. ________________________________ Amount _____________________________________
