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Application for Degree

Please download and read the graduation guidelines before filling out this form. (PDF)
Payment is not required at the time of application. You may pay online, in person at the business office or mail your payment.

* Indicates required field.

Student's First Name: *
Student's Last Name: *
Student's SS# *
Belhaven ID# *
Address where graduation information should be sent
Street Address: *
City: *
State: *
Zip: *
Home Phone: *
Work Phone:
Cell/Other Phone: *
E-Mail: *
(to be printed in commencement program)
Are you a Belhaven legacy (child, spouse,
grandchild, etc. of a Belhaven alumnus)?
Yes   No *
Campus Student Attended: *
I expect to have all degree requirements completed by: Month: *
Year: *


Select a Degree Program: *
Jackson Traditional Students
Graduate/Adult Studies

Method of Payment:
Note: The $100 fee is a Graduation Audit Fee.  It is required whether or not one plans to walk in a graduate ceremony.
Credit Card  (Credit card payment can be
     made through a secure server once this
     form has been submitted.)
Money Order

I have read and understand the graduation policies.  I understand that if I fail to complete all degree requirements by the date above, I will be required and it is my responsibility to re-submit an Application for Graduation form, along with a possible graduation fee, by the appropriate deadline.

Before degrees are officially granted, grades must be recorded and records rechecked for total hours, quality points, and other degree requirements.  Participation in graduation exercises is not a guarantee of graduation.

Applicant's Legal Signature: *
  (Type full name)
Today's Date: *
Agreed acts as your signature: Yes  No *

Print a copy of this form for your records before pressing "submit."