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Graduation Petition

By completing the Graduation Petition form below, you are requesting the Records and Registration Office to review your records to determine if you have completed all academic requirements for graduation. A response to this petition will be mailed to the address you provide. Clark State's holds one graduation ceremony annually in June.

If you plan to graduate Spring or Summer quarters, submit your petition between February 1 - March 30. If you submit this petition after May 1, your name may not appear in the graduation ceremony program.

If you plan to graduate Fall or Winter quarters, submit your petition between August 1 - January 30.

Name
Please check here if you have a new address.
Street Address
City
State
Zip Code
Student ID No.
Major

Anticipated quarter of graduation:

Have you graduated from another college? Yes No

If yes, what degree did you earn?

I request that the following name appear on my diploma:


I will will not participate in the graduation ceremony. Please notify the Records and Registration Office if your plans change regarding attending graduation.

Records and Registration
Rhodes Hall
937/328-6015
E-Mail Us

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