Date: ______________________________

Student ID Number: _____________________ Tulane Email Address: _________________________ Cell Phone #: _______________________

_______________________________________________________ Signature of Applicant

Advisor’s Use Only

Undergraduate Application for Degree/Certificate

My name should appear on my diploma as follows:

First Name: _____________________________________________________________________________________________________

Middle Name: ___________________________________________________________________________________________________

Last Name: ______________________________________________________________________________ Suffix: ________________

If your account is encumbered by Accounts Receivable or Student Loans, you must first clear your account before your diploma can be released.

I certify that I have read the requirements for graduation as presented in the catalog of my School and that to the best of my knowledge, I meet all of them or will meet all of them by the expected date of graduation.

At the Fall 20___________ Spring Commencement 20___________ Summer 20___________

I expect to receive the following degree(s)/certificate(s): *Certificates conferred by Tulane University, not state or federal certifications.

School_______________________ Degree_______________________ Certificate*_________________________

Major 1_____________________ Major 2____________________ Minor 1______________________ Minor 2_______________________

Home Town: (to be printed in commencement program) City:___________________________________ State/Country:_______________________

You are required to meet with your academic advisor to complete this form.

Summer or Fall Graduation:Diploma Delivery:Mail my diploma to the following address. If a valid address is not provided, your diploma will be mailed to your permanent addresson file. Note that a $10 mailing fee will be charged to your account.

Physical Address:________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Commencement Participation:q I will participate in the next commencement. q I will NOT participate in the next commencement.

Spring Commencement:q I am attending commencement. q I am not attending commencement.

Diploma DeliveryMail my diploma to the following address. If a valid address is not provided, your diploma will be mailed to your permanent addresson file. Note that a $10 mailing fee will be charged to your account.

Physical Address: ______________________________________________________________________________________________________

_____________________________________________________________________________________________________________________