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Application for Graduation Form


COLLEGE OF AGRICULTURE, SCIENCE AND EDUCATION (CASE) OFFICE OF THE REGISTRAR APPLICATION FORM FOR GRADUATION
NAME: __________________________________________________
Last

_____________________________________
First

__________________________ GENDER: M ? ??F ???
Middle

(Please ensure that your name is spelt how you want it to appear on your Degree/Diploma) Address: __________________________________________________________________________Tel #: ____________________ E-Mail Address:___________________________ ENROLLMENT STATUS: Full-Time ???

Year of Entry: ________________________________



Part-Time

???

I.D. #: ___________________________

Instructions: Please indicate the programme you pursued by placing a tick (√) in the appropriate box.

? ??Bachelor of Technology, Agri-Food Systems ? ??Bachelor of Technology, Environmental Sc. ? ??Bachelor of Education, Primary ? ??Associate Degree, General Agriculture ? ??Associate Degree, Agricultural Education ? ??Associate Degree, Natural Science ? ??Associate Degree, Business Studies ? ??Associate Degree, Hospitality & Tourism ? ??Diploma, Agriculture ? ??Diploma, Primary Teaching ? ??Diploma, Secondary Teaching (M/C) ? ??Diploma, Teaching (by Advanced Placement)
Place/Address of Employment (If employed):_________________________________________________________________________________________________________________

Tel. ____________________Job Title: _____________________________Annual Salary Range: ___________________Suggestions for Valedictorian: 1. ________________________ 2. ________________________ 3.__________________________________ Will you be attending the Graduation Ceremony ? ??Yes

? ??No
Date: _____________________________

Graduand’s Signature: _____________________________________ For Official Use Only (Graduands, please do not write in this section)

Is the candidate eligible for Graduation?: ? ??Yes ? ??No. If no, state reason (s): _____________________________________________________________________ _______________________________________________________________________________________________________________________________________

Official Signatures: _______________ Director of Finance

________________ Date (YY/MM/DD)

_________________________ ______________ Dean: FOS ? ??FOA ? ??FOE ? ??Date (YY/MM/DD)

_____________
Registrar

______________
Date (YY/MM/DD)



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