Kentucky State University
Application for Graduate Degree
Degree Checkout Form
(Form Revised February 2006)
Instructions: The student must apply for graduation the semester/session prior to the actual date of graduation. The deadline for submittal are outlined in the Academic Calendar in the University Catalogue and the semester Information Booklet.
The student must complete Section I of this form, sign in Section IV, and submit this application to the division chairperson or dean.
The department must complete Section II, Section 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 of 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.
Name: ___
Note: Print Full name as it is to appear on diploma.
Date: ___
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Hometown (Required)
Current Email: ___
Current Phone: ___
Name on University records (If different than above): ___
Address after Street: ___ Apt: ___
Graduation
City: _____ State: _____ Zip:
State: _____ Zip: _____
Advisor: ___
Degree: ___ Catalogue of Record: ___ Grad. Date: ___
Program: ___ Area(s) of Specialization: ___
(please add additional courses on additional sheets if needed)
(please add additional courses on additional course
Prefix & No. Title Hours
Prefix & No. Title Hours
Spring: ________ (If Applicable)
Summer: ___ (If Applicable)
Prefix & No. ___ Title ___ Hours ___
Will courses in progress meet the minimum graduation hours required for the degree?
O
Yes O No
Has a comprehensive examination been completed? ○Yes ○No ○Not required
Has a thesis or major project been completed? ○Yes ○No ○Not required
Student: ___
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Advisor: ___
Date: ___
Program Coordinator: ___
Date: ___
Masters Department Head: ___
Date: ___
College Dean: ___
Date: ___
Director of Graduate Studies: ___
Date: ___
Registrar Certification: ___
Date: ___
Date: ___
Kentucky