APPLICATION FOR GRADUATION
 Florissant Valley  Forest Park  Meramec  Wildwood
Student ID No.
A
Name ___________________________________________________________
(Last Name)
(First Name)
(MI)
Please complete this form in its entirety and submit it to the Admissions/Registration office by the deadlines listed
below. The Registration office will notify you of your graduation status.
Semester in which you plan to graduate:
 Summer
 Fall
 Spring
Deadline for filing: June 20 October 1 March 1
PRINT or TYPE your name as you would like it to appear on your diploma:
First ____________________________ Middle ___________________________ Last ____________________________
Address _______________________________________________ City __________________ State ______ Zip ___________
Day Phone _____________________ Evening Phone ____________________ E-mail Address ____________________________
TYPE OF DEGREE YOU SEEK:
NOTE: Curriculum denotes major field of study. Option denotes special focus within the major field of study.
 Associate in Arts
 Associate of Arts in Teaching
 Certificate of Proficiency
 Associate in Science
 Associate in Applied Science
 Certificate of Specialization
 Associate in Fine Arts
 Certificate of General Education
Curriculum ______________________________________________ Option ________________________________________
An academic advisor or counselor must verify that all degree requirements have been met:
_______________________________________________________________________________________________
Advisor/Counselor Signature
Date
Catalog Year/Curriculum Code
Comments: ______________________________________________________________________________________
A form of exit assessment is required if you are receiving an AA, AS, AFA, AAT or AAS degree. A letter will
be sent to you with the detailed information and testing times.
Student Signature ________________________________________________________ Date _______________________
— Admissions/Registration Office Use Only —
Date Application Received in Office:
Notes:
First Check __________ Final Check __________
Exit Exam __________ Entered __________ LTR __________
Date Rec’d. ______________ By __________
Distribution: White & Yellow – Admissions/Registration or Advisor/Counselor; Pink – Student 11-100-032 9/11