Revised 2/2020
UNDERGRADUATE SENIOR CLEARANCE FORM
It is the potential graduate’s responsibility to ensure that this form is completed and submitted to the registrar’s office prior
to receiving graduation materials (cap and gown, diploma, final transcript, etc.). *All signatures should be obtained except
the Provost/VP of Academic Affairs and the Registrar when the form is submitted.
Student’s Name ____________________________________________________________
ID# ________________________
Email ____________________________________________________________________
Phone _____________________
Please sign below in the appropriate space, indicating that the above mentioned student is in good standing and has settled all
outstanding responsibilities in your area.
_________________________________________________________________________
Advisor
Date _______________________
_________________________________________________________________________
Chair/Director
Date _______________________
_________________________________________________________________________
Dean/Director
Date _______________________
_________________________________________________________________________
Business Office (Sumner Hall, Room 122)
Date _______________________
_________________________________________________________________________
VP Institutional Research
Date _______________________
_________________________________________________________________________
Career Pathways (Swayne Hall, 2nd Floor)
Date _______________________
_________________________________________________________________________
Financial Aid (Seymour Hall, Room 11)
Date _______________________
_________________________________________________________________________
Provost/VP for Academic Affairs (Dr. Lisa Long, Seymour Hall, Room 9)
Date _______________________
________________________________________________________________________
Registrar (Mrs. Barbara Smith, Seymour Hall, Room 9)
Date _______________________
