APPLICATION FOR GRADUATE DEGREE CHECKOUT FORM KENTUCKY STATE UNIVERSITY - OFFICE OF THE REGISTRAR (Revised 2022)
The student must apply for graduation the semester prior to the date of graduation. The deadline for submittal is found in the Academic Calendar.
The student must complete section I of this form, sign Section IV, and submit this application to the division chairperson or dean.
The department must complete Section II, III, and signature portion of Section IV of this form and submit to Office of Graduate Studies.
The department must attach a copy of the curriculum checklist with notations of completed, substituted and waived courses.
Upon receipt, the Office of the Registrar will complete the preliminary degree audit and notify the student and department of the status of the Application for Graduate Degree.
I. Student Information
SID: _____ Expected Grad Date: _____ (Ex: Spring 2022)
SID
Expected Grad Date
Name: ___ Hometown (Required) ___
Name
Hometown (Required
Note: Print full name as it is to appear on diploma
Name on University records (If different than above):
Name on University records (If different than above
Current E-mail: ___ Current Phone Number: ___
Current E-mail
Current Phone Number
Address after graduation: ___
Address after graduation
City State Zip
Street
Advisor:_____ Catalog/Entry:_____
Advisor
Catalog/Entry
Specialization
Degree: ___ Program: ___ Specialization:
Degree
Program
II. Courses in Progress (For transfer courses, identify institution after course number)
Fall ___ (If applicable) Spring ___ (If applicable) Summer ___ (If applicable)
Fall
Spring
Summer
Prefix & No. Title Hrs. Prefix & No. Title Hrs. Prefix & No. Title Hrs.
_____ _____ _____
Prefix & No. Title [1]
Prefix & No [1]
Hrs
Prefix & No. Title [2]
Prefix & No [2]
[1]
Will courses in progress meet the minimum graduation hours required for the degree
Prefix & No [3]
[2]
[3]
Will courses in progress meet the minimum graduation hours required for the degree? Yes No
III. Thesis and Comprehensive Examination
Has a comprehensive examination been completed? ☐ Yes ☐ No ☐ Not Required ☐ In Progress Has a thesis or major project been completed? ☐ Yes ☐ No ☐ Not Required ☐ In Progress
Yes
No
Not Required
In Progress
Not Required
In Progress
Yes
No
IV. Signature (Sign and Date)
Student: ___
Student
Date:
Date
\[ ext{Advisor:}\underline{\quad\quad\quad\quad
Advisor
Date
Program Coordinator: ___ Date: ___
Program Coordinator
Date
College Dean
College Dean:
Date: ___
Date
Director of Graduate Studies: _____ Date: _____
Director of Graduate Studies
Date: ___
Date
Registrar Certification: _____ Date: _____
Registrar Certification
Date: ___
Date
It is the Policy of Kentucky State University not to discriminate against any individual in any of its educational programs, activities, or employment on the basis of race, color, national origin, sex, disability, veteran status, age, religion, or marital status.