Student Info
Legal last name * First name * NLC Student Number *
Daytime Telephone Number * Birthdate (yyyy/mm/dd) *
Email Address*
Credential Info
Your Name (print your name EXACTLY as you wish it to appear on your parchment) *
Full name of program you are applying to graduate from *
Level of program you are applying to graduate from (choose one only) *
Certificate Diploma Post-Degree Diploma Associate Degree
Semester you completed/will complete the program *
Fall 20____ Winter 20____ Other:____________________
Do you need a Post-Graduate Work Permit support letter to be issued with your parchment? (international students only) *
Yes No Not applicable
Convocation & Parchment
Convocation Ceremony (choose one only) *
Your response is for internal planning purposes only; you can update
your answer later on the Convocation Registration form.
Yes, I plan to attend the Dawson Creek ceremony
Yes, I plan to attend the Fort St John ceremony
Yes, I plan to attend the Fort Nelson ceremony
No, I do not plan to attend
Convocation ceremonies are held in June each year. All students eligible
to graduate are invited and will be sent a Convocation Registration Form
in March to fill out to confirm attendance at the ceremony.
All June 2021 convocation ceremonies will be held online.
Parchment Delivery (choose one only)
*
All students who meet graduation requirements are issued one official
NLC parchment.
I would like my parchment presented to me at the Convocation
ceremony
I will pick up at ___________________ campus as soon as possible
Photo ID is required for pick-up
You will be contacted when it is ready for you to pick-up
Mail to my address (must fill in address details in the section
below)
Address Info
Address you want your Credential mailed to:
Mailing Address
City Province Country Postal code
Would you like us to update your current mailing address on file with the above details? Yes No
Signature
Student records are confidential and are not released without the written consent of the student, unless otherwise required by law. NLC considers
falsified requests to be fraudulent. Your signature indicates you are requesting to graduate and the information you provided on this form is
correct.
Student Signature*
Date*
Office Use Only
Campus Services Clerk
Ensure form is complete
Update email and mailing address in Colleague if applicable
Scan and send form to Student Records
Processed by (initials): Date received:
Updated January 2021 An Office of the Registrar form
REQUEST TO GRADUATE
Use this form to apply to graduate.
See Page 2 for detailed instructions.
* indicates a required field
click to sign
signature
click to edit