APPLICATION FOR GRADUATION - May 2008

Please READ & COMPLETE All Fields - then Click the Submit button (at the bottom of the form)

Do you plan to attend graduation?  Yes: Yes No
 
Legal Name:   Last:   First:   Middle Initial:
 

YOUR NAME EXACTLY AS YOU WISH IT TO APPEAR ON DIPLOMA:
 

MAILING ADDRESS AND PHONE NUMBER:
 
 Street:
  
City:
 		  State:
  		Zip:
 		  County:
 
 Day Phone:
  		Evening Phone:
 

PROGRAM INFORMATION:
 
Program Name:
 Specialty Name:
 Date of Completion:
 Degree (AS, AAS, TC):
Did you attend Ivy Tech before fall of 1990?
Yes:      No: 		When:
 Where:

 

Unless you have filed a form to prohibit the release of "Public Directory Information," your name may be released for newspaper publication.  Your residence will be assumed to be the city our town you listed for your mailing address.

ALUMNI RECORD (person who can assist us in reaching you after graduation, other than in your household):
 
Name:
 Telephone:
Address:
  		City:
 State:
Zip:
 

PLACEMENT INFORMATION:
 
Present Employer:
 Position:
Address:
  		City:
 State:
Zip:
Supervisor's Name:
Starting Salary:
  		Current Salary:
 Number of Hours per week:

Which of the following employment services do you wish to use?   (Check ALL that apply)
 Job Referral  Job/Career Fair
 Resume Critique  Interview Techniques
 Job Search Counseling  Mock Interviews
 Job Skills Credit Course Job Bulletin Board
 Workshop Seminar  
 

This is only an application for graduation and not a guarantee that you meet all requirements for your diploma.  It is recommended that you make an appointment with your program advisor for a review of your academic record.

Please click "Submit" to send Form or click "Reset" to clear form