Rogers State University
Graduation Application
Name: _________________________________________ Student ID #: ____________________________
Major: _________________________ Code: _______ Minor: _____________________ Code: _______
Bulletin Year under which the student is requesting plan review __________________________________
Student is applying to GRADUATE in the ____________________________semester of ______________
(Fall or Spring or Summer) (Year)
_____________________________________________________________________________________________
Address City State Zip
_____________________________________________________________________________________________
Phone Email
Please list your name as you would like it to appear on your diploma:
First Middle Last Suffix
Please see website/bulletin for graduation application deadlines.
A. Hours Completed: _____________ (Must be applicable to degree)
B. Hours Currently Enrolled: _____________
C. Hours Yet To Be Completed: _____________
TOTAL: _____________
Courses Needed To Complete Degree (B + C):
Course Term Credit Hours
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
________________________ _______________ ______________
(Must equal “Hours Currently Enrolled” + “Hours Yet To Be Completed”) T
otal Hours Needed: _________________
Student Signature Date Advisor Signature Date
Dept. Head Date Dean Date
Signing this form indicates that you are approving the change of your Major/Minor, Address, Phone and Email to what
you have indicated above. Once reviewed by the Registrar, the plan will either be approved or change noted that will be
communicated to the advisor who will contact the student. Approved copies will be sent to the department of record and
the student.
Graduation completion means:
1. “Courses Needed To Complete Degree” are satisfactorily completed.
2. There are no enrollment changes made to the schedule(s) attached.
3. Graduation / Retention G.P.A. is 2.00 or above.
_____________________________________________ ________________________________
Registrar’s Signature Date Approved Revised 05/12
Graduation Application checklist: _____ Graduation Application _____ Degree Check _____ Transcript ____ Course Substitution
