Application For Degree Certificate Diploma

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Received by: _________ on_______

APPLICATION FOR DEGREE/CERTIFICATE/DIPLOMA


($10.00 for each Degree/Certificate/Diploma or $25.00 each to be mailed to student)

LEGAL NAME: STUDENT ID NUMBER:


LAST FIRST M.I. (e.g. SSN, Driver’s License...)

DATE OF BIRTH:
If you have used another name at GCC, list here.

MAILING ADDRESS: GENDER: ( ) MALE ( ) FEMALE


P.O BOX OR HOME MAILING ADDRESS

TELEPHONE :
VILLAGE TERRITORY/STATE ZIP CODE

I am meeting or have met requirements for: Associate Degree Certificate Adult High School Vocational High School

If Degree or Certificate, what program:


(Example:ACCOUNTING, COMPUTER SCIENCE, COSMETOLOGY, etc.)

I am applying under the requirements as stated in the GCC Catalog edition.


I EXPECT TO GRADUATE ON:
_____________________________
I wish to have my name appear on the degree/certificate/diploma exactly as follows: SEM ESTER/YEAR

(PRINT YOUR LEGAL NAM E AS YOU DESIRE IT TO APPEAR ; INCLUDE SPACES AND CAPITALIZATIONS)

( ) I DO WISH ( ) I DO NOT WISH TO PARTICIPATE IN THE GRADUATION CEREMONY TO BE HELD IN MAY.


Please answer the following questions carefully and completely as you can. Your answers will help to reconstruct and/or verify
your records.

I have attended: Adult High School/College Program from 19 to 19 to 20


Vocational High School Program from 20 to 20 to 20

GCC should have received transcripts of my work from the following institution(s):

STUDENT’S SIGNATURE: DATE:


BUSINESS & FINANCE USE ONLY

Does this student have an outstanding obligation to the College? ( ) Yes ( ) No


Number of Degree/Certificate/Diplomas ordered: Amount: Receipt Number:

ADMISSIONS & REGISTRATION OFFICE USE ONLY

Date admitted to GCC:_______ Semester Hours completed to date:__________ TOTAL TRANSFER of credits:___________
Residency requirements _____ Met _____ Not Met These courses are:_______________________________________
Cumulative Grade Point Average (GPA): ______________ as of __________.
Recommended for GRADUATION: DIPLOMA ORDERED: ADD TO GRADUATE LIST:
_____ Yes __________ ____________________ _____ Yes _____ No __________ _____ Yes _____ No __________
Graduation Date Program Initials/Date Initials/Date
_____ No (Comments:___________________________________________________________________________________)
_____ UPON COMPLETION OF THE ABOVE REQUIREMENTS
1. REGISTRAR 2. STUDENT FILE 3. STUDENT COPY (mailed to student after processed)
REVISED:04/06

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