[ { "page": 1, "items": [ { "page": 1, "type": "TITLE", "location": { "l": 124.32, "t": 684.96, "r": 487.2, "b": 649.68 }, "text": "APPLICATION FOR UNDERGRADUATE DEGREE CHECKOUT FORM\nKENTUCKY STATE UNIVERSITY - OFFICE OF THE REGISTRAR\n(Revised 2022)", "reading_order": 0, "level": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 34.32, "t": 636.24, "r": 560.4, "b": 626.16 }, "text": "The student must apply for graduation the semester prior to the date of graduation. The deadline for submittal is found in the Academic Calendar.", "reading_order": 1 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 53.28, "t": 624.24, "r": 545.04, "b": 613.92 }, "text": "The student must complete section I of this form, sign Section IV, and submit this application to the division chairperson or dean.", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 2 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 53.28, "t": 612.24, "r": 519.36, "b": 601.92 }, "text": "Approval must be obtained for minors/second majors from the appropriate divisional chairperson (and sign in Section IV).", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 3 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 53.28, "t": 600.48, "r": 522.24, "b": 590.16 }, "text": "The department must attach a copy of the curriculum checklist with notations of completed, substituted and waived courses.", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 4 }, { "page": 1, "type": "TITLE", "location": { "l": 52.32, "t": 575.76, "r": 187.92, "b": 565.2 }, "text": "I. Student Information", "reading_order": 5, "level": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 51.6, "t": 554.88, "r": 439.68, "b": 543.84 }, "text": "SID: ___ Expected Grad Date: ___ (Ex: Spring 2022)", "reading_order": 6 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 75.84, "t": 556.08, "r": 171.12, "b": 545.52 }, "text": "SID", "field_kind": "text", "label": "SID", "pdf_field_name": "SID", "pdf_field_type": "Text", "reading_order": 7 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 273.36, "t": 556.08, "r": 363.6, "b": 545.52 }, "text": "Expected Grad Date", "field_kind": "text", "label": "Expected Grad Date", "pdf_field_name": "Expected Grad Date", "pdf_field_type": "Text", "reading_order": 8 }, { "page": 1, "type": "TEXT", "location": { "l": 52.08, "t": 534.48, "r": 511.68, "b": 523.2 }, "text": "Name: ___ Hometown (Required) ___", "reading_order": 9 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 84.12, "t": 535.68, "r": 284.4, "b": 525.12 }, "text": "Name", "field_kind": "text", "label": "Name", "pdf_field_name": "Name", "pdf_field_type": "Text", "reading_order": 10 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 390, "t": 535.68, "r": 510, "b": 525.12 }, "text": "Hometown (Required", "field_kind": "text", "label": "Hometown (Required", "pdf_field_name": "Hometown Required", "pdf_field_type": "Text", "reading_order": 11 }, { "page": 1, "type": "TEXT", "location": { "l": 53.04, "t": 522.24, "r": 511.44, "b": 512.16 }, "text": "Note: Print full name as it is to appear on diploma", "reading_order": 12 }, { "page": 1, "type": "TEXT", "location": { "l": 51.6, "t": 492, "r": 513.84, "b": 480.24 }, "text": "Name on University records (If different than above):___", "reading_order": 13 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 282.24, "t": 492.96, "r": 512.16, "b": 482.4 }, "text": "Name on University records (If different than above", "field_kind": "text", "label": "Name on University records (If different than above", "pdf_field_name": "Name on University records If different than above", "pdf_field_type": "Text", "reading_order": 14 }, { "page": 1, "type": "TEXT", "location": { "l": 51.84, "t": 471.6, "r": 514.32, "b": 459.6 }, "text": "Current E-Mail: ___ Current Phone Number: ___", "reading_order": 15 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 127.44, "t": 472.2, "r": 282.48, "b": 461.64 }, "text": "Current E-Mail", "field_kind": "text", "label": "Current E-Mail", "pdf_field_name": "Current EMail", "pdf_field_type": "Text", "reading_order": 16 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 392.88, "t": 472.2, "r": 512.88, "b": 461.64 }, "text": "Current Phone Number", "field_kind": "text", "label": "Current Phone Number", "pdf_field_name": "Current Phone Number", "pdf_field_type": "Text", "reading_order": 17 }, { "page": 1, "type": "TEXT", "location": { "l": 51.84, "t": 450.96, "r": 513.12, "b": 440.16 }, "text": "Address after graduation: ___", "reading_order": 18 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 167.16, "t": 452.16, "r": 512.04, "b": 441.6 }, "text": "Address after graduation", "field_kind": "text", "label": "Address after graduation", "pdf_field_name": "Address after graduation", "pdf_field_type": "Text", "reading_order": 19 }, { "page": 1, "type": "TEXT", "location": { "l": 66.48, "t": 437.04, "r": 479.04, "b": 426.48 }, "text": "Street City State Zip", "reading_order": 20 }, { "page": 1, "type": "TEXT", "location": { "l": 69.6, "t": 427.2, "r": 481.44, "b": 416.16 }, "text": "Advisor: ___ Catalog/Entry: ___ Catalog/Major: ___", "reading_order": 21 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 105.72, "t": 429.24, "r": 191.28, "b": 418.92 }, "text": "Advisor", "field_kind": "text", "label": "Advisor", "pdf_field_name": "Advisor", "pdf_field_type": "Text", "reading_order": 22 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 262.32, "t": 429.24, "r": 334.32, "b": 418.92 }, "text": "Catalog/Entry", "field_kind": "text", "label": "Catalog/Entry", "pdf_field_name": "CatalogEntry", "pdf_field_type": "Text", "reading_order": 23 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 398.4, "t": 429.24, "r": 479.4, "b": 418.92 }, "text": "Catalog/Major", "field_kind": "text", "label": "Catalog/Major", "pdf_field_name": "CatalogMajor", "pdf_field_type": "Text", "reading_order": 24 }, { "page": 1, "type": "TEXT", "location": { "l": 70.08, "t": 406.08, "r": 479.04, "b": 394.32 }, "text": "Degree: ___ First Major: ___ First Minor: ___", "reading_order": 25 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 102.72, "t": 407.16, "r": 188.28, "b": 396.6 }, "text": "Degree", "field_kind": "text", "label": "Degree", "pdf_field_name": "Degree", "pdf_field_type": "Text", "reading_order": 26 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 254.04, "t": 407.16, "r": 335.04, "b": 396.6 }, "text": "First Major", "field_kind": "text", "label": "First Major", "pdf_field_name": "First Major", "pdf_field_type": "Text", "reading_order": 27 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 387.84, "t": 407.16, "r": 477.72, "b": 396.6 }, "text": "First Minor", "field_kind": "text", "label": "First Minor", "pdf_field_name": "First Minor", "pdf_field_type": "Text", "reading_order": 28 }, { "page": 1, "type": "TEXT", "location": { "l": 69.84, "t": 383.52, "r": 479.76, "b": 372 }, "text": "Second Major: ___ Second Minor: ___ Specialization: ___", "reading_order": 29 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 127.56, "t": 384.84, "r": 199.44, "b": 374.28 }, "text": "Second Major", "field_kind": "text", "label": "Second Major", "pdf_field_name": "Second Major", "pdf_field_type": "Text", "reading_order": 30 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 264.48, "t": 384.84, "r": 332.04, "b": 374.28 }, "text": "Second Minor", "field_kind": "text", "label": "Second Minor", "pdf_field_name": "Second Minor", "pdf_field_type": "Text", "reading_order": 31 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 396.72, "t": 384.84, "r": 477.84, "b": 374.28 }, "text": "Specialization", "field_kind": "text", "label": "Specialization", "pdf_field_name": "Specialization", "pdf_field_type": "Text", "reading_order": 32 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 51.84, "t": 360, "r": 481.2, "b": 348.24 }, "text": "II. Courses in Progress (For transfer courses, identify institution after course number)", "marker": "II.", "list_id": "L2", "level": 0, "reading_order": 33 }, { "page": 1, "type": "TEXT", "location": { "l": 51.84, "t": 346.8, "r": 454.56, "b": 336.24 }, "text": "Fall ___ (If applicable) Spring ___ (If applicable) Summer ___ (If applicable)", "reading_order": 34 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 70.32, "t": 348.6, "r": 106.2, "b": 338.28 }, "text": "Fall", "field_kind": "text", "label": "Fall", "pdf_field_name": "Fall", "pdf_field_type": "Text", "reading_order": 35 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 213, "t": 348.6, "r": 249, "b": 338.28 }, "text": "Spring", "field_kind": "text", "label": "Spring", "pdf_field_name": "Spring", "pdf_field_type": "Text", "reading_order": 36 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 357.6, "t": 348.6, "r": 398.16, "b": 338.28 }, "text": "Summer", "field_kind": "text", "label": "Summer", "pdf_field_name": "Summer", "pdf_field_type": "Text", "reading_order": 37 }, { "page": 1, "type": "TEXT", "location": { "l": 52.08, "t": 324.72, "r": 428.16, "b": 314.16 }, "text": "Prefix & No. Title Hrs. Prefix & No. Title Hrs. Prefix & No. Title Hrs.", "reading_order": 38 }, { "page": 1, "type": "TEXT", "location": { "l": 48.96, "t": 310.8, "r": 420.96, "b": 299.76 }, "text": "— _____ _____", "reading_order": 39 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 54, "t": 315.12, "r": 157.56, "b": 304.8 }, "text": "Prefix & No. Title [1]", "field_kind": "text", "label": "Prefix & No. Title [1]", "pdf_field_name": "Prefix No Title 1", "pdf_field_type": "Text", "reading_order": 40 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 175.56, "t": 315.12, "r": 283.56, "b": 304.8 }, "text": "Prefix & No. Title [1]", "field_kind": "text", "label": "Prefix & No. Title [1]", "pdf_field_name": "Prefix No Title 1_2", "pdf_field_type": "Text", "reading_order": 41 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 303.96, "t": 315.12, "r": 425.52, "b": 304.8 }, "text": "Prefix & No. Title [1]", "field_kind": "text", "label": "Prefix & No. Title [1]", "pdf_field_name": "Prefix No Title 1_3", 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"reading_order": 46 }, { "page": 1, "type": "TEXT", "location": { "l": 54, "t": 306, "r": 426.24, "b": 269.04 }, "text": "___\n___\n___\n___", "reading_order": 47 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 175.56, "t": 304.2, "r": 283.56, "b": 293.64 }, "text": "Prefix & No. Title [2]", "field_kind": "text", "label": "Prefix & No. Title [2]", "pdf_field_name": "Prefix No Title 2_2", "pdf_field_type": "Text", "reading_order": 48 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 175.56, "t": 293.04, "r": 283.56, "b": 282.48 }, "text": "Prefix & No. Title [3]", "field_kind": "text", "label": "Prefix & No. Title [3]", "pdf_field_name": "Prefix No Title 3_2", "pdf_field_type": "Text", "reading_order": 49 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 175.56, "t": 281.88, "r": 283.56, "b": 271.32 }, "text": "Prefix & No. Title [4]", "field_kind": "text", "label": "Prefix & No. Title [4]", "pdf_field_name": "Prefix No Title 4_2", "pdf_field_type": "Text", 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"field_kind": "text", "label": "Prefix & No. Title [6]", "pdf_field_name": "Prefix No Title 6_2", "pdf_field_type": "Text", "reading_order": 54 }, { "page": 1, "type": "TEXT", "location": { "l": 301.68, "t": 310.56, "r": 427.68, "b": 268.56 }, "text": "___", "reading_order": 55 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 303.96, "t": 304.2, "r": 425.4, "b": 293.64 }, "text": "Prefix & No. Title [2]", "field_kind": "text", "label": "Prefix & No. Title [2]", "pdf_field_name": "Prefix No Title 2_3", "pdf_field_type": "Text", "reading_order": 56 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 303.96, "t": 293.04, "r": 425.52, "b": 282.48 }, "text": "Prefix & No. Title [3]", "field_kind": "text", "label": "Prefix & No. Title [3]", "pdf_field_name": "Prefix No Title 3_3", "pdf_field_type": "Text", "reading_order": 57 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 303.96, "t": 281.88, "r": 425.52, "b": 271.32 }, "text": "Prefix & No. Title [4]", "field_kind": "text", "label": "Prefix & No. Title [4]", "pdf_field_name": "Prefix No Title 4_3", "pdf_field_type": "Text", "reading_order": 58 }, { "page": 1, "type": "TITLE", "location": { "l": 51.6, "t": 232.32, "r": 522.72, "b": 220.56 }, "text": "III. Requirements (with above courses, will the applicant complete the following requirements?)", "reading_order": 59, "level": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 53.28, "t": 218.64, "r": 388.08, "b": 197.52 }, "text": "Are Liberal Studies Requirements completed (check applicable core)? ☐ Yes ☐ No\nGeneral Core (42 hours) Whitney Young Core (48 hours)", "reading_order": 60 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 360.6, "t": 218.76, "r": 372.72, "b": 209.76 }, "text": "No", "field_kind": "text", "label": "No", "pdf_field_name": "No", "pdf_field_type": "Text", "reading_order": 61 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 322.32, "t": 218.52, "r": 334.32, "b": 209.64 }, "text": "Yes", "field_kind": "text", "label": "Yes", "pdf_field_name": "Yes", "pdf_field_type": "Text", "reading_order": 62 }, { "page": 1, "type": "TEXT", "location": { "l": 52.56, "t": 186.72, "r": 474.24, "b": 163.68 }, "text": "Will courses in progress meet the minimum graduation hours required for the degree (120 hours)? ☐Yes ☐No\nWill courses in progress meet the minimum requirement for 300/400 level hours (42 hours)? ☐Yes ☐No", "reading_order": 63 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 415.32, "t": 185.16, "r": 427.44, "b": 176.28 }, "text": "Yes", "field_kind": "text", "label": "Yes", "pdf_field_name": "Yes_2", "pdf_field_type": "Text", "reading_order": 64 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 448.2, "t": 185.16, "r": 460.32, "b": 176.28 }, "text": "No", "field_kind": "text", "label": "No", "pdf_field_name": "No_2", "pdf_field_type": "Text", "reading_order": 65 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 393.36, "t": 173.16, "r": 405.48, "b": 164.28 }, "text": "Yes", "field_kind": "text", "label": "Yes", "pdf_field_name": "Yes_3", "pdf_field_type": "Text", "reading_order": 66 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 430.8, "t": 172.92, "r": 442.92, "b": 164.04 }, "text": "No", "field_kind": "text", "label": "No", "pdf_field_name": "No_3", "pdf_field_type": "Text", "reading_order": 67 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 52.32, "t": 151.2, "r": 191.28, "b": 141.36 }, "text": "IV. Signature (Sign and Date)", "marker": "IV.", "list_id": "L3", "level": 0, "reading_order": 68 }, { "page": 1, "type": "TEXT", "location": { "l": 51.84, "t": 138.48, "r": 241.68, "b": 129.84 }, "text": "Student: ___", "reading_order": 69 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 86.28, "t": 141.72, "r": 239.28, "b": 131.64 }, "text": "Student", "field_kind": "text", "label": "Student", "pdf_field_name": "Student", "pdf_field_type": "Text", "reading_order": 70 }, { "page": 1, "type": "TEXT", "location": { "l": 282.72, "t": 139.68, "r": 402.96, "b": 130.08 }, "text": "Date:", "reading_order": 71 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 306, "t": 142.791, "r": 402.334, "b": 131.64 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "Date", "pdf_field_type": "Text", "reading_order": 72 }, { "page": 1, "type": "TEXT", "location": { "l": 52.32, "t": 128.16, "r": 403.44, "b": 119.04 }, "text": "Advisor: ___ Date: ___", "reading_order": 73 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 306.377, "t": 132.814, "r": 402.12, "b": 120.48 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "Date_2", "pdf_field_type": "Text", "reading_order": 74 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 87.72, "t": 131.04, "r": 240.84, "b": 120.48 }, "text": "Advisor", "field_kind": "text", "label": "Advisor", "pdf_field_name": "Advisor_2", "pdf_field_type": "Text", "reading_order": 75 }, { "page": 1, "type": "TEXT", "location": { "l": 52.8, "t": 117.36, "r": 402.72, "b": 107.52 }, "text": "Dept. Chairperson: _____ Date _____", "reading_order": 76 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 306, "t": 120.471, "r": 402.334, "b": 109.32 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "Date_3", "pdf_field_type": "Text", "reading_order": 77 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 124.8, "t": 119.88, "r": 241.92, "b": 109.32 }, "text": "Dept. Chairperson", "field_kind": "text", "label": "Dept. 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