Request for Change of Graduation Term
Re-Filing Degree Application ($15.00 fee)
This form is to be used by students who have previously submitted an
Application for Degree and Diploma form and who desire to change their graduation term
Name: ____________________________________________________ Student ID: _______________
Phone Number: ____________________ E-mail: ___________________________________________
Anticipated Graduation Term:
This is the term in which all University and Major/Minor requirements are completed
Term (circle one): Fall / Spring / Summer
Year: __________
Diploma Name
PRINT name exactly as you wish it to appear on your diploma.
Note: This name must be the same as we have in our records. If you have legally changed your name, you must submit a
Name Change form & documentation to the Registrar’s Office front desk in Sage Hall before the end of your final term.
__________________________ __________________________ __________________________
First Name Middle Name Last Name
Degree Objective: BA BS MA MS MBA Certificate
Major/Program/Emphasis: ___________________________________________________________________
Minor/Certificate (if declared): _______________________________________________________________
Second Major (if declared): _________________________________________________________________
Second Minor/Certificate (if declared): _________________________________________________________
Note: Please run your CI Academic Requirements Report (CARR) in CI Records and verify that your major(s)/minor(s) are
displaying correctly at the top. If you do not see a major or minor listed, you will need to submit a Change of Major/Minor
form to the Registrar’s Office.
Payment of non-refundable $15.00 fee to Student Business Services needs to accompany this form. The form
must be submitted by mail or in person to the SBS window, located in Sage Hall. Applications without the fee
will not be processed.
Student’s Signature ____________________________________________ Date ____________________
Administrative Use Only- Student Business Services
____Re-Filing Fee $15.00 Check ____ Cash_____ By: _________________ Date: _____________
*** PLEASE SEND COMPLETED APPLICATION TO THE REGISTRAR’S OFFICE FOR PROCESSING***
Administrative Use Only-Registrar’s Office
Processed by: _______ PS Update: _______ Term Activation: _______ Registration App.t: _______ AGU/AGP _______
(Staff Initials) (Date) Revised 4/3/19
Registrar’s Office
One University Drive
Camarillo, CA 93012
Phone: (805) 437-8500
