Last Updated: March 23, 2020
Processing fees received:
TO BE COMPLETED BY STUDENT: (Please Print) STUDENT ID NUMBER: _______________________
LAST NAME: ___________________ FIRST NAME: ___________________ PHONE: ________________________
ADDRESS: ____________________________________ CITY: _____________ STATE: _____ ZIP CODE: _________
FORMER GRADUATION DATE: Term (FALL, SPRING, or SUMMER) _______________ YEAR: _________
NEW GRADUATION DATE: Term (FALL, SPRING, or SUMMER) _______________ YEAR: _________
_______________________________________________________________
Student’s Signature Date
I approve the above named student’s request to change their graduation term to the term indicated above.
____________________________________________________________________________________ _____________________
Major Advisor’s Name (Please Print) Major Advisor’s Signature Date
____________________________________________________________________________________ _____________________
Minor Advisor’s Name (Please Print) Minor Advisor’s Signature Date
REQUEST FOR CHANGE OF
GRADUATION DATE
Office of Admissions and Records (WH 290)
Please email the completed form with required signatures to graduation@csudh.edu
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signature
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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