Degree Form
Employee Information
Employee Name:
Department/Division:
Position/Title:
Phone:
E-mail:
Fax:
Campus Location:
Degree Information
Name and Address of Institution:
Proposed Degree:
Anticipated Completion Date:
Employee Statement
Why this degree will be beneficial to my current position or a future position at the college:
(Attach a sheet indicating courses that you have already taken and courses
that you will complete in the future to fulfill your degree requirements.)
Employee Signature:
Date:
Executive Director, Human Resources:
Date:
For Human Resources Use Only:
Transcripts Received ________________________ Assignment Changed _______________