Graduation Petition Form Link

Application for Degree/Certificate

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

First Name Last Name
Student ID#
Address *

Street Address

Street Address Line 2

City State / Province

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

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

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

Accounting, AAS Administrative Office Professional, AAS Business Administration, AAS Criminal Justice, AAS Dental Hygiene, AAS Emergency Medical Services-Paramedic, AAS Information Technology & Cyber Security, AAS Medical Assistant, AAS Medical Office Professional, AAS Mortuary Science, AAS Nursing (RN), AAS Process Maintenance Technology, AAS Radiologic Technology, AAS Other
Certificate: Please check the box which pertains to you.

Accounting Certificate Administrative Office Assistant Certificate Agriculture Certificate American Welding Society - Level 1 Certificate Automotive Technology Certificate Basic Industrial & Mechanical Maintenance Certificate CISCO Network Associate Certificate CNC Operator Certificate CNC Programmer Certificate Computed Tomography Certificate Computer Support Associate Certificate Computer Technician Certificate Criminal Justice Certificate Cyber Security Specialist Certificate Emergency Medical Services - Paramedic Certificate Entrepreneurship and Small Business Management Certificate Health Care Assistant Certificate Industrial Mechanical Maintenance Certificate Magnetic Resonance Imaging Certificate Medical Assisting Certificate Medical Office Assistant Certificate Network Security Associate Certificate Patient Care Technician Certificate Phlebotomy Technician Certificate Practical Nursing Certificate Other
Indicate the year of the CSC catalog which you are following to graduate: *
Example 19-20, 20-21:
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 *

Month Day Year
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Office Use Only

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EVAL Sent: ________ Graduated:________
Should be Empty:

Application for Degree/Certificate