===== PAGE 1 =====
# 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)

Name: ___ Hometown (Required) ___

Note: Print full name as it is to appear on diploma

Name on University records (If different than above):

Current E-mail: ___ Current Phone Number: ___

Address after graduation: ___

City State Zip

Street

Advisor:_____ Catalog/Entry:_____

Degree: ___ Program: ___ Specialization:

### II. Courses in Progress (For transfer courses, identify institution after course number)

Fall ___ (If applicable) Spring ___ (If applicable) Summer ___ (If applicable)

Prefix & No. Title Hrs. Prefix & No. Title Hrs. Prefix & No. Title Hrs.

_____ _____ _____

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

### IV. Signature (Sign and Date)

Student: ___

Advisor: _____

Program Coordinator: ___

College Dean:

Director of Graduate Studies: _____

Date: _____



Registrar Certification: _____

Date: _____



Date: ___

Date: ___

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.