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# 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.

### I. Student Information Student ID: ___

Date: ___

Name: ___

Note: Print Full name as it is to appear on diploma.



Current Email: ___

Hometown (Required)

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: ___

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

(please add additional courses on additional sheets if needed)


<table border=1 style='margin: auto; word-wrap: break-word;'><tr><td style='text-align: center; word-wrap: break-word;'>(please add additional courses on additional course</td><td style='text-align: center; word-wrap: break-word;'>Spring: ________ (If Applicable)</td></tr><tr><td style='text-align: center; word-wrap: break-word;'>Prefix &amp; No. Title Hours</td><td style='text-align: center; word-wrap: break-word;'>Prefix &amp; No. Title Hours</td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr><tr><td style='text-align: center; word-wrap: break-word;'></td><td style='text-align: center; word-wrap: break-word;'></td></tr></table>

Summer: ___ (If Applicable)

Prefix & No. ___ Title ___ Hours ___

Will courses in progress meet the minimum graduation hours required for the degree?

O

Yes O No

### III. Thesis and Comprehensive Examination Section

Has a comprehensive examination been completed? ○Yes ○No ○Not required

Has a thesis or major project been completed? ○Yes ○No ○Not required

### IV. Signature Section

Student: ___

Advisor: ___

Program Coordinator: ___

Masters Department Head: ___

College Dean: ___

Director of Graduate Studies: ___

Registrar Certification: ___

Date: ___



Date: ___

Date: ___

Date: ___

Date: ___

Date: ___

Date: ___

Kentucky