Application For Graduation

Name*

Prefix First Middle Last Suffix

Student ID#*

Date of Birth*

Personal Email Address*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Alternative Phone Number

Credential Level*

Degree
Diploma
Certificate

Completion Term

Summer
Fall
Spring

Completion Year

Will you be participating in the graduation ceremony?

Yes
No

If YES, please provide your HEIGHT:

If YES, please provide your WEIGHT:

If you have a physical disability and require an accommodation for graduation, select all that apply and contact Disability Services at 706.649.1442, Hartline Bldg Room 161

Wheelchair Access
ASL Interpreter
Other

Please provide this information for the Career Placement Office

Employment Status – Select the item that most closely describes your current status

Employer Name

Job Title

Employer Address

Email Address

Website

Please initial to indicate you understand the following: If graduation requirements are not met by the term above, I must reapply by completing a new graduation application.*

Please initial to indicate you understand the following: All financial obligations must be settle with Columbus Technical College before I receive my credential.*

Please initial to indicate you understand the following: Notification of credential pick-up will be mailed 45 days after the end of your graduating semester.*

Please initial to indicate you understand the following: There is a $40 mandatory graduation fee assessed to all graduating students.*

Email

Date

Application for Graduation

Please provide this information for the Career Placement Office