[ { "page": 1, "items": [ { "page": 1, "type": "TITLE", "location": { "l": 143.76, "t": 684.96, "r": 467.28, "b": 648.48 }, "text": "APPLICATION FOR GRADUATE DEGREE CHECKOUT FORM\nKENTUCKY STATE UNIVERSITY - OFFICE OF THE REGISTRAR\n(Revised 2022)", "reading_order": 0, "level": 1 }, { "page": 1, "type": "TEXT", "location": { "l": 33.6, "t": 632.64, "r": 561.6, "b": 622.56 }, "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": 53.04, "t": 620.16, "r": 541.68, "b": 610.56 }, "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": 53.76, "t": 609.12, "r": 568.56, "b": 599.04 }, "text": "The department must complete Section II, III, and signature portion of Section IV of this form and submit to Office of Graduate Studies.", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 3 }, { "page": 1, "type": "LIST_ITEM", "location": { "l": 53.04, "t": 597.12, "r": 523.2, "b": 586.8 }, "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": "LIST_ITEM", "location": { "l": 53.52, "t": 585.12, "r": 571.2, "b": 563.76 }, "text": "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.", "marker": "•", "list_id": "L1", "level": 0, "reading_order": 5 }, { "page": 1, "type": "TITLE", "location": { "l": 51.84, "t": 549.84, "r": 188.4, "b": 538.32 }, "text": "I. Student Information", "reading_order": 6, "level": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 51.36, "t": 528.48, "r": 439.44, "b": 517.2 }, "text": "SID: _____ Expected Grad Date: _____ (Ex: Spring 2022)", "reading_order": 7 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 75.84, "t": 529.56, "r": 171.12, "b": 519.24 }, "text": "SID", "field_kind": "text", "label": "SID", "pdf_field_name": "SID", "pdf_field_type": "Text", "reading_order": 8 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 273.36, "t": 529.56, "r": 363.6, "b": 519.24 }, "text": "Expected Grad Date", "field_kind": "text", "label": "Expected Grad Date", "pdf_field_name": "Expected Grad Date", "pdf_field_type": "Text", "reading_order": 9 }, { "page": 1, "type": "TEXT", "location": { "l": 51.84, "t": 508.08, "r": 496.8, "b": 497.52 }, "text": "Name: ___ Hometown (Required) ___", "reading_order": 10 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 84.12, "t": 509.16, "r": 269.4, "b": 498.84 }, "text": "Name", "field_kind": "text", "label": "Name", "pdf_field_name": "Name", "pdf_field_type": "Text", "reading_order": 11 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 379.92, "t": 509.16, "r": 495.24, "b": 498.84 }, "text": "Hometown (Required", "field_kind": "text", "label": "Hometown (Required", "pdf_field_name": "Hometown Required", "pdf_field_type": "Text", "reading_order": 12 }, { "page": 1, "type": "TEXT", "location": { "l": 52.08, "t": 496.32, "r": 227.28, "b": 486.24 }, "text": "Note: Print full name as it is to appear on diploma", "reading_order": 13 }, { "page": 1, "type": "TEXT", "location": { "l": 51.6, "t": 465.84, "r": 282.72, "b": 454.56 }, "text": "Name on University records (If different than above):", "reading_order": 14 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 282.12, "t": 466.44, "r": 497.04, "b": 456.12 }, "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": 15 }, { "page": 1, "type": "TEXT", "location": { "l": 51.84, "t": 444.72, "r": 501.36, "b": 433.92 }, "text": "Current E-mail: ___ Current Phone Number: ___", "reading_order": 16 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 126.12, "t": 445.68, "r": 301.2, "b": 435.36 }, "text": "Current E-mail", "field_kind": "text", "label": "Current E-mail", "pdf_field_name": "Current Email", "pdf_field_type": "Text", "reading_order": 17 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 409.2, "t": 445.68, "r": 499.32, "b": 435.36 }, "text": "Current Phone Number", "field_kind": "text", "label": "Current Phone Number", "pdf_field_name": "Current Phone Number", "pdf_field_type": "Text", "reading_order": 18 }, { "page": 1, "type": "TEXT", "location": { "l": 51.36, "t": 419.76, "r": 503.28, "b": 409.44 }, "text": "Address after graduation: ___", "reading_order": 19 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 167.16, "t": 421.2, "r": 502.2, "b": 410.88 }, "text": "Address after graduation", "field_kind": "text", "label": "Address after graduation", "pdf_field_name": "Address after graduation", "pdf_field_type": "Text", "reading_order": 20 }, { "page": 1, "type": "TEXT", "location": { "l": 64.32, "t": 406.56, "r": 464.16, "b": 397.68 }, "text": "City State Zip", "reading_order": 21 }, { "page": 1, "type": "TEXT", "location": { "l": 167.04, "t": 407.76, "r": 191.04, "b": 398.4 }, "text": "Street", "reading_order": 22 }, { "page": 1, "type": "TEXT", "location": { "l": 69.84, "t": 396, "r": 349.92, "b": 386.16 }, "text": "Advisor:_____ Catalog/Entry:_____", "reading_order": 23 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 105.72, "t": 398.52, "r": 200.28, "b": 388.2 }, "text": "Advisor", "field_kind": "text", "label": "Advisor", "pdf_field_name": "Advisor", "pdf_field_type": "Text", "reading_order": 24 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 271.32, "t": 398.52, "r": 347.76, "b": 388.2 }, "text": "Catalog/Entry", "field_kind": "text", "label": "Catalog/Entry", "pdf_field_name": "CatalogEntry", "pdf_field_type": "Text", "reading_order": 25 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 417.12, "t": 376.2, "r": 493.56, "b": 365.88 }, "text": "Specialization", "field_kind": "text", "label": "Specialization", "pdf_field_name": "Specialization", "pdf_field_type": "Text", "reading_order": 26 }, { "page": 1, "type": "TEXT", "location": { "l": 69.36, "t": 374.64, "r": 416.64, "b": 364.8 }, "text": "Degree: ___ Program: ___ Specialization:", "reading_order": 27 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 102.72, "t": 376.2, "r": 183.72, "b": 365.88 }, "text": "Degree", "field_kind": "text", "label": "Degree", "pdf_field_name": "Degree", "pdf_field_type": "Text", "reading_order": 28 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 253.2, "t": 376.2, "r": 352.32, "b": 365.88 }, "text": "Program", "field_kind": "text", "label": "Program", "pdf_field_name": "Program", "pdf_field_type": "Text", "reading_order": 29 }, { "page": 1, "type": "TITLE", "location": { "l": 52.08, "t": 351.36, "r": 484.32, "b": 340.32 }, "text": "II. Courses in Progress (For transfer courses, identify institution after course number)", "reading_order": 30, "level": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 51.6, "t": 338.4, "r": 454.8, "b": 327.84 }, "text": "Fall ___ (If applicable) Spring ___ (If applicable) Summer ___ (If applicable)", "reading_order": 31 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 70.32, "t": 340.2, "r": 106.2, "b": 329.88 }, "text": "Fall", "field_kind": "text", "label": "Fall", "pdf_field_name": "Fall", "pdf_field_type": "Text", "reading_order": 32 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 213, "t": 340.2, "r": 249, "b": 329.88 }, "text": "Spring", "field_kind": "text", "label": "Spring", "pdf_field_name": "Spring", "pdf_field_type": "Text", "reading_order": 33 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 357.6, "t": 340.2, "r": 398.16, "b": 329.88 }, "text": "Summer", "field_kind": "text", "label": "Summer", "pdf_field_name": "Summer", "pdf_field_type": "Text", "reading_order": 34 }, { "page": 1, "type": "TEXT", "location": { "l": 51.84, "t": 316.32, "r": 461.52, "b": 306.48 }, "text": "Prefix & No. Title Hrs. Prefix & No. Title Hrs. Prefix & No. Title Hrs.", "reading_order": 35 }, { "page": 1, "type": "TEXT", "location": { "l": 51.12, "t": 303.6, "r": 432.48, "b": 281.76 }, "text": "_____ _____ _____", "reading_order": 36 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 54, "t": 306.72, "r": 157.56, "b": 296.4 }, "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": 37 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 175.56, "t": 306.72, "r": 283.56, "b": 296.4 }, "text": "Prefix & No [1]", "field_kind": "text", "label": "Prefix & No [1]", "pdf_field_name": "Prefix No 1", "pdf_field_type": "Text", "reading_order": 38 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 303.96, "t": 306.72, "r": 425.4, "b": 296.4 }, "text": "Hrs", "field_kind": "text", "label": "Hrs", "pdf_field_name": "Hrs", "pdf_field_type": "Text", "reading_order": 39 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 54, "t": 295.56, "r": 157.56, "b": 285.24 }, "text": "Prefix & No. Title [2]", "field_kind": "text", "label": "Prefix & No. Title [2]", "pdf_field_name": "Prefix No Title 2", "pdf_field_type": "Text", "reading_order": 40 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 175.56, "t": 295.56, "r": 283.56, "b": 285.24 }, "text": "Prefix & No [2]", "field_kind": "text", "label": "Prefix & No [2]", "pdf_field_name": "Prefix No 2", "pdf_field_type": "Text", "reading_order": 41 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 303.96, "t": 295.56, "r": 425.52, "b": 285.24 }, "text": "[1]", "field_kind": "text", "label": "[1]", "pdf_field_name": "1", "pdf_field_type": "Text", "reading_order": 42 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 54, "t": 284.4, "r": 157.56, "b": 274.08 }, "text": "Will courses in progress meet the minimum graduation hours required for the degree", "field_kind": "text", "label": "Will courses in progress meet the minimum graduation hours required for the degree", "pdf_field_name": "Will courses in progress meet the minimum graduation hours required for the degree", "pdf_field_type": "Text", "reading_order": 43 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 175.56, "t": 284.4, "r": 283.56, "b": 274.08 }, "text": "Prefix & No [3]", "field_kind": "text", "label": "Prefix & No [3]", "pdf_field_name": "Prefix No 3", "pdf_field_type": "Text", "reading_order": 44 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 372, "t": 284.4, "r": 408.72, "b": 274.08 }, "text": "[2]", "field_kind": "text", "label": "[2]", "pdf_field_name": "2", "pdf_field_type": "Text", "reading_order": 45 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 413.04, "t": 284.4, "r": 425.52, "b": 274.08 }, "text": "[3]", "field_kind": "text", "label": "[3]", "pdf_field_name": "3", "pdf_field_type": "Text", "reading_order": 46 }, { "page": 1, "type": "TEXT", "location": { "l": 51.84, "t": 271.68, "r": 425.52, "b": 261.36 }, "text": "Will courses in progress meet the minimum graduation hours required for the degree? Yes No", "reading_order": 47 }, { "page": 1, "type": "TITLE", "location": { "l": 51.36, "t": 246, "r": 281.04, "b": 234.72 }, "text": "III. Thesis and Comprehensive Examination", "reading_order": 48, "level": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 52.08, "t": 233.76, "r": 445.2, "b": 211.2 }, "text": "Has a comprehensive examination been completed? ☐ Yes ☐ No ☐ Not Required ☐ In Progress\nHas a thesis or major project been completed? ☐ Yes ☐ No ☐ Not Required ☐ In Progress", "reading_order": 49 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 249.96, "t": 232.2, "r": 262.2, "b": 223.2 }, "text": "Yes", "field_kind": "text", "label": "Yes", "pdf_field_name": "Yes", "pdf_field_type": "Text", "reading_order": 50 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 286.2, "t": 232.2, "r": 298.44, "b": 223.2 }, "text": "No", "field_kind": "text", "label": "No", "pdf_field_name": "No", "pdf_field_type": "Text", "reading_order": 51 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 320.76, "t": 232.2, "r": 333, "b": 223.2 }, "text": "Not Required", "field_kind": "text", "label": "Not Required", "pdf_field_name": "Not Required", "pdf_field_type": "Text", "reading_order": 52 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 389.28, "t": 232.2, "r": 401.52, "b": 223.2 }, "text": "In Progress", "field_kind": "text", "label": "In Progress", "pdf_field_name": "In Progress", "pdf_field_type": "Text", "reading_order": 53 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 320.76, "t": 219.24, "r": 333, "b": 210.24 }, "text": "Not Required", "field_kind": "text", "label": "Not Required", "pdf_field_name": "Not Required_2", "pdf_field_type": "Text", "reading_order": 54 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 389.4, "t": 219.12, "r": 401.52, "b": 210.36 }, "text": "In Progress", "field_kind": "text", "label": "In Progress", "pdf_field_name": "In Progress_2", "pdf_field_type": "Text", "reading_order": 55 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 249.96, "t": 218.64, "r": 262.08, "b": 209.64 }, "text": "Yes", "field_kind": "text", "label": "Yes", "pdf_field_name": "Yes_2", "pdf_field_type": "Text", "reading_order": 56 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 286.2, "t": 218.28, "r": 298.44, "b": 209.28 }, "text": "No", "field_kind": "text", "label": "No", "pdf_field_name": "No_2", "pdf_field_type": "Text", "reading_order": 57 }, { "page": 1, "type": "TITLE", "location": { "l": 52.08, "t": 198.24, "r": 213.12, "b": 186.96 }, "text": "IV. Signature (Sign and Date)", "reading_order": 58, "level": 2 }, { "page": 1, "type": "TEXT", "location": { "l": 52.08, "t": 183.12, "r": 263.52, "b": 174.72 }, "text": "Student: ___", "reading_order": 59 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 86.28, "t": 186.84, "r": 261.84, "b": 176.64 }, "text": "Student", "field_kind": "text", "label": "Student", "pdf_field_name": "Student", "pdf_field_type": "Text", "reading_order": 60 }, { "page": 1, "type": "TEXT", "location": { "l": 300.48, "t": 184.08, "r": 420, "b": 174.96 }, "text": "Date:", "reading_order": 61 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 324.12, "t": 186.96, "r": 418.56, "b": 176.64 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "Date", "pdf_field_type": "Text", "reading_order": 62 }, { "page": 1, "type": "TEXT", "location": { "l": 52.32, "t": 173.28, "r": 419.52, "b": 163.2 }, "text": "\\[\text{Advisor:}\\underline{\\quad\\quad\\quad\\quad", "reading_order": 63 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 87.72, "t": 175.8, "r": 263.28, "b": 165.48 }, "text": "Advisor", "field_kind": "text", "label": "Advisor", "pdf_field_name": "Advisor_2", "pdf_field_type": "Text", "reading_order": 64 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 323.4, "t": 175.8, "r": 417.6, "b": 165.48 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "Date_2", "pdf_field_type": "Text", "reading_order": 65 }, { "page": 1, "type": "TEXT", "location": { "l": 52.32, "t": 161.52, "r": 419.52, "b": 152.16 }, "text": "Program Coordinator: ___ Date: ___", "reading_order": 66 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 135.6, "t": 164.52, "r": 266.04, "b": 154.2 }, "text": "Program Coordinator", "field_kind": "text", "label": "Program Coordinator", "pdf_field_name": "Program Coordinator", "pdf_field_type": "Text", "reading_order": 67 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 323.88, "t": 164.52, "r": 418.32, "b": 154.2 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "Date_3", "pdf_field_type": "Text", "reading_order": 68 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 108, "t": 153.36, "r": 265.44, "b": 143.04 }, "text": "College Dean", "field_kind": "text", "label": "College Dean", "pdf_field_name": "College Dean", "pdf_field_type": "Text", "reading_order": 69 }, { "page": 1, "type": "TEXT", "location": { "l": 52.8, "t": 151.68, "r": 108, "b": 141.84 }, "text": "College Dean:", "reading_order": 70 }, { "page": 1, "type": "TEXT", "location": { "l": 299.76, "t": 150.24, "r": 419.52, "b": 141.36 }, "text": "Date: ___", "reading_order": 71 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 323.28, "t": 153.36, "r": 417.72, "b": 143.04 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "Date_4", "pdf_field_type": "Text", "reading_order": 72 }, { "page": 1, "type": "TEXT", "location": { "l": 52.08, "t": 140.4, "r": 267.12, "b": 130.32 }, "text": "Director of Graduate Studies: _____\nDate: _____", "reading_order": 73 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 162.48, "t": 142.2, "r": 265.92, "b": 131.88 }, "text": "Director of Graduate Studies", "field_kind": "text", "label": "Director of Graduate Studies", "pdf_field_name": "Director of Graduate Studies", "pdf_field_type": "Text", "reading_order": 74 }, { "page": 1, "type": "TEXT", "location": { "l": 300.72, "t": 139.92, "r": 420, "b": 129.84 }, "text": "Date: ___", "reading_order": 75 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 323.76, "t": 142.2, "r": 418.2, "b": 131.88 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "Date_5", "pdf_field_type": "Text", "reading_order": 76 }, { "page": 1, "type": "TEXT", "location": { "l": 52.08, "t": 128.16, "r": 267.12, "b": 117.84 }, "text": "Registrar Certification: _____\nDate: _____", "reading_order": 77 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 139.56, "t": 130.2, "r": 265.32, "b": 119.88 }, "text": "Registrar Certification", "field_kind": "text", "label": "Registrar Certification", "pdf_field_name": "Registrar Certification", "pdf_field_type": "Text", "reading_order": 78 }, { "page": 1, "type": "TEXT", "location": { "l": 300, "t": 127.92, "r": 420.24, "b": 117.84 }, "text": "Date: ___", "reading_order": 79 }, { "page": 1, "type": "FORM_FIELD", "location": { "l": 323.52, "t": 130.08, "r": 418.56, "b": 119.76 }, "text": "Date", "field_kind": "text", "label": "Date", "pdf_field_name": "Date_6", "pdf_field_type": "Text", "reading_order": 80 }, { "page": 1, "type": "TEXT", "location": { "l": 33.84, "t": 103.44, "r": 534.48, "b": 81.12 }, "text": "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.", "reading_order": 81 } ] } ]