Revised 08/2020
Please complete this form and return to the Registrar’s Office with the curriculum pattern evaluation
obtained from your department chair. Print or type requested information unless signature is requested.
Provide name below as you would like it listed on your diploma and in the commencement program.
Student ID#. ___________________________
Height: __________________
Weight: ________________
Last Name: ____________________________
First Name: _______________
Middle Name: ___________
Mailing Address: ____________________________________________________________________________
City: __________________________________
State: ____________________
Zip Code: _______________
Hometown City/State/Country: ________________________________________________________________
Phone: ________________________________
Email: ____________________________________________
Major: ____________________________________________________________________________________
Concentration (if applicable): __________________________________________________________________
Minor (if applicable): ________________________________________________________________________
I affirm that the following requirements have been met (or are being met as indicated):
1. General Education Courses. Met: ______ Will be met:
2. Overall GPA of 2.0 or higher. Met: ______ Will be met:
3. If you are an Education major, have you completed Requirements for Teacher Certification in Alabama
as stipulated by the Department of Education? Met: Will be met:
4. Do you plan to participate in the commencement ceremony? Yes: _____ No: ______
I understand that this application does not certify that I am cleared for graduation. A final degree audit
must be completed by the Registrar certifying that academic requirements have been met.
All outstanding issues and debts must be cleared with the institution including the graduation fee.
I certify that the above information is true and accurate to the best of my knowledge:
Student’s Signature: _____________________________________________
Date: _____________________
Advisor’s Signature: _____________________________________________
Date: _____________________
Chair’s/Director’s Signature: ______________________________________
Date: _____________________
Dean’s/Director’s Signature: ______________________________________
Date: _____________________