Graduation Petition Form Link

Application for Degree/Certificate

Admissions & Records Office | 309.341.5233 | asnow@sandburg.edu
Name*

First NameLast Name
Student ID#
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Print your name as you wish it to appear on your degree or certificate:*

First NameMiddle Name or initial (optional)Last Name
Indicate the term you plan to finish
Please select an option from the drop down menu
Year*
Example: 2021
Attendance Center:*
Please check the box which pertains to you.*

Transfer Degree or AGS Objective:Career Technical Edu. or Health Professions AAS/Certificate Objective:
Transfer Degree or AGS Objective: Please check the box which pertains to you.

Associate in ArtsAssociate in General Studies (Not intended as transfer degree)Associate in Science (STEM majors)Associate in Fine Arts in ArtOther
Career Technical Edu. or Health Professions AAS/Certificate Objective:: Please check the box which pertains to you.*

Associate in Applied Science inCertificate in
Associate in Applied Science Degree: Please check the box which pertains to you.

Accounting, AASAdministrative Office Professional, AASAgribusiness, AASAgricultural Mechanization, AASBusiness Administration, AASCriminal Justice, AASDental Hygiene, AASIndustrial Maintenance, AASInformation Technology & Cyber Security, AASMedical Assistant, AASMedical Office Professional, AASMortuary Science, AASNursing (RN), AASRadiologic Technology, AASWelding, AASOther
Indicate the year of the CSC catalog which you are following to graduate: *
Example 19-20, 20-21:
Certificate: Please check the box which pertains to you.

Accounting CertificateAdministrative Office Assistant CertificateAdvanced Agriculture CertificateAdvanced Industrial Maintenance CertificateAdvanced Welding CertificateAgribusiness CertificateBasic Agriculture CertificateBasic Welding CertificateAutomotive Technology CertificateAgricultural Mechanization CertificateCISCO Network Associate CertificateCNC Operator CertificateCNC Programmer CertificateComputed Tomography CertificateComputer Support Associate CertificateComputer Technician CertificateCriminal Justice CertificateEntrepreneurship and Small Business Management CertificateMagnetic Resonance Imaging CertificateMedical Assisting CertificateMedical Office Assistant CertificateNetwork Security Associate CertificatePractical Nursing CertificateOther
I plan to participate in the May graduation ceremony:*
*Note If more than five years have passed since your initial enrollment in academic program as indicated above, you may choose a more recent (five years or less) version of the academic program.

If you have any additional information which may pertain to this evaluation: please note accordingly.
College transfer credit from which school:
Course Substitutes filed:
Signature*
Date*

MonthDayYear
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Office Use Only

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EVAL Sent: ________ Graduated:________
Should be Empty:

Application for Degree/Certificate