AUGUST GRADUATION

 

(December commencement ceremony)




PART I
Application for Degree
Office of the Registrar
(815) 836-5217
 
* Required  
*Student ID:
*Name:
[Please FILL IN EXACTLY as you wish it to appear on diploma.]

NOTE: Please contact Registrar's Office if your name contains multicultural accents.
 
*Name Phonetic Pronunciation:
Sample Name: Beethoven      Pronunciation: Bay-toe-ven
 
Current Address [Where we can contact you PRIOR TO Graduation.]
*Address:
*City:
*State:
*Zip Code:
   
Home Address [Where we can contact you AFTER Graduation.]
                                                   Copy from Current Address:
*Address:
*City:
*State:
*Zip Code:
   
Phone(s):
*Daytime Phone:
*Cell Phone:
   
*Lewis Email Address (all correspondence will be sent to this email):
 
*Please re-enter Lewis Email Address:
 
Other Email Address:
 
Please re-enter Other Email Address:
*College [Check one]
Arts and Sciences Education
Business Nursing and Health Professions
 
*Degree [Check one]
2-yr Aviation (06) Associate (08) Bachelor's
Master's Certificate of Advanced Study Doctorate
   
Major: 1)
  2)
Minor: 1)
  2)
 
   
Please Note: If for any reason you find that you will not graduate on the date designated above, please contact the Registrar's Office and withdraw your application. You must re-apply for a future date. Your application is not carried over automatically to the next graduation date.
 

PART II

 
ADULT/GRADUATE/CERTIFICATE of ADVANCED STUDY/DOCTORAL
Directions: Please check the box that best describes your plans after graduation. Your responses will provide us with important information about your experience at Lewis.
*
I will continue in my current position within my current organization
  Employer:
  Location:
  Position/Title:
 
I will have/will be seeking a new position within my current organization
  Employer:
  Location:
  New Position/Title:
 
I have obtained a new career opportunity
  Employer:
  Location:
  Position/Title:
   
I plan to pursue additional degrees or certification
  Program:
Degree:
  College/University:
   
I am unsure of my plans at this time
   
Other (Please describe):
 
 
*How closely will your career or graduate school plans be related to your major field?
  Very closely related
In the same general area
Slightly related
Not at all related
I don't know
 
What aspect of your education at Lewis had the most impact on your career?
 
 
 
*Signature:
Date: 5/25/2013