Microsoft Word - RGA Retro Graduation 0713

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RetroactiveGraduationApplication

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Requiredafterthe6weekgraduationgraceperiodhaselapsed.

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TheLateGraduationApplicationcanbeusedforthecurrenttermifthe

onlineapplicationdeadlinehaspassedandthe6weekgraduationgraceperiodhasnotelapsed.

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 Acurrentdegreeevaluationshowingcompletionofdegreerequirementsmustbeattached.

 DiplomasfrompastsemesterswillcontainthesignaturesofthecurrentUniversityPresident,RectoroftheBoardofVisitors,Provost,and

UniversityRegistrar.

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Eligibility:

 Allrequirements(courses,testandpapers)weremetanddocumentedintheRegistrar’sOfficeatthetimeofrequested

graduationdate.

 Noadditions/changeshavebeenmadetotherecordssincethattime.

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Name: _________________________________________________________MasonStudentID#__________________________

Last  First

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DaytimePhone:_________________________________________Email:_______________________________________________

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DiplomaMailingAddress(Required):

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Street:________________________________________ Apt#:________________City,State:__________________________

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Zip:___________Country(ifnotUSA):_________

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GraduationTermRequested:

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Semester Year

ReasonforRequest: 

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DegreeprogramasofyourrequestedGraduationTerm:

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Note:Newdegreecomponents,changedordeclared,requireagraduationdateafterthatchange.

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Degree:

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 Major/Program:

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SecondaryComponents:

2ndMajor: ___________________________ Concentration:________________________

Minor: ___________________________ 2ndMinor: ________________________

Certificate: ___________________________

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Student’sSignature:________________________________________________________________________________

DepartmentApproval:

 MajorRequirementsmetperattacheddegreeaudit Denied,majorrequirementsnotmetperattacheddegreeaudit

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DepartmentChairNameandSignatureDate

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DeanNameandSignatureDate

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MinorDepartmentSignature (ifapplicable)Date

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ProvostSignature(ifapplicable)Date

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Afterapprovalsignatureshavebeenobtained,returnthisformtotheOfficeoftheUniversityRegistrar,StudentUnionBldg1,Room2101MS3D1,Fax(703)993‐4668.

FinalUniversityApproval–OfficeoftheUniversityRegistrar

Approved‐GraduationTerm:  Denied‐Reason: 

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Registrar’sInitials:_________/__________7/13

DEGREE