DACC Intent to Graduate (with an Associate Degree)

Application 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.)

__Science &Arts __Engineering Science __Applied Science __General Studies

(Transfer) (Transfer) (Vocational/Career)

6. Please indicate your major/area of study:

_____________________________________________________________________________

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

Hours Earned: ______ Hours Enrolled: ______ Transfer Hours:______ Cum GPA: ______

High School and Graduation Date/GED Information: ______________________________________________

______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:_____ Sent to Registrar:_____ Letter Sent:_____

Honors/PTK:_____ Posted:_____ Diploma Sent:_____

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.)
__Science &Arts	__Engineering Science	__Applied Science	__General Studies
(Transfer)	(Transfer)	(Vocational/Career)
6. Please indicate your major/area of study:
_____________________________________________________________________________

______________________________	________	_________________________________	_________
Advisor/Counselor	Date	Registrar	Date