1INTENT TO GRADUATE CARD-Return to SBU Office of the Registrar, 1600 University Ave, Bolivar MO 65613

Student Number: Social Security #: Today’s Date:

PRINT YOUR NAME AS YOU WANT IT ON YOUR DIPLOMA AND IN THE GRADUATION PROGRAM

First Middle Last

Completing Requirements: May 20_______ July 20

_______ Dec 20_______
First Major: Second Major: Minor:

Degrees (Circle): AA AAS AS ASN BA BAS BS BM BSN MBA DPT MS MS.EDAD EDSPEC
Address where you may be contacted 2
months before graduation:
Do you have need of special assistance in processing/recessing or in using a ramp when receiving your diploma during commencement ceremony?
YES NO (circle one): If YES, explain:
For Graduation Regalia Sizing: Height: Weight: Sex: M F
A Student who does not graduate as his intent specifies, must re-apply for graduation and FEE PAID
will be charged a second nonrefundable graduation fee.
Diploma mailing address:

NOTE: Your signature permits SBU to print your name in the graduation program and to release
graduation information to the media.
Stamp and Date
Office Use Only
Signature: