DACC Intent to Graduate (with an Associate Degree)

Intent to Graduate (with an Associate Degree)
Danville Area Community College

This form is to be filled out after you have seen a counselor and know that you will be graduating. If you need to know what requirements are needed before you are eligible to graduate, you must see an Academic Advisor or Counselor (Lincoln Hall, Room 104).

Please PRINT legibly and fill in all blanks. Print your name exactly as you want it to appear on your diploma.

1. _____________________________________________________________________________

     Last Name                                 First Name                          Middle Name or Initial

2. _____________________________________________________________________________

     Street Address or P.O. Box #               City                          State          Zip Code

3. _____________________________________________________________________________

     Social Security Number/Student I.D.
Today’s Date

4. Indicate the term and year in which you will complete the courses for your degree:

Fall _______   Spring _______   Summer _______

5. I will be a candidate for an Associate Degree in: (Please select one of the following.)

____ Arts ____ Science ____ Science &Arts ____ Engineering Science ____ Applied Science

(Transfer) (Transfer) (Transfer) (Transfer) (Vocational/Career)

6. Please indicate your major/area of study:

_____________________________________________________________________________

*************************FOR DACC OFFICE USE ONLY*************************

Hours Earned: ______ Hours Enrolled: ______ Transfer Hours:______ Constitution: ______

High School and Graduation Date/GED Information: ______________________________________________

Post Testing Required: CAAP WorkKeys Completed:__________________________

______This student is eligible to graduate.
______This student is eligible to graduate pending completion of current courses.
______This student is not eligible to graduate due to the following deficiencies:

___________________________________________________________________________________

___________________________________________________________________________________

______________________________________ ______________________________________

Advisor/Counselor Date Registrar Date

Sent for Initial Review:__________ Sent to Division:_____________ Letter Sent:_____________
Posted on SIS:_____________

Records
DACC

1. _____________________________________________________________________________
Last Name First Name Middle Name or Initial
2. _____________________________________________________________________________
Street Address or P.O. Box # City State Zip Code
3. _____________________________________________________________________________
Social Security Number/Student I.D.	Today’s Date
4. Indicate the term and year in which you will complete the courses for your degree:
Fall _______ Spring _______ Summer _______

5. I will be a candidate for an Associate Degree in: (Please select one of the following.)
____ Arts	____ Science	____ Science &Arts	____ Engineering Science	____ Applied Science
(Transfer)	(Transfer)	(Transfer)	(Transfer)	(Vocational/Career)
6. Please indicate your major/area of study:
_____________________________________________________________________________

______________________________________		______________________________________
Advisor/Counselor	Date	Registrar	Date