ID Number    Campus Box Number (Lamoni Only)
E-mail    Phone

Your name as you want it to appear on your diploma (first, middle, last):

Your hometown as you want it to appear on the commencement program:

Bachelor of Arts
Bachelor of Science
*Bachelor of Science in Nursing
*Bachelor of Science in Nursing/
      Master of Science in Nursing
*Master of Science in Nursing
*Doctor of Nursing Practice

Bachelor of Arts Honors
Bachelor of Science Honors
*Bachelor of Science in Nursing Honors
*Master of Education
*Master of Arts in Religion
*Master of Arts in Christian Ministries

Year and Month all requirements will be completed:

January     February   March   April   May   June  
July   August   September   October   November   December

Do you plan to attend a Commencement ceremony?   Yes   No  
If yes, which one do you plan to attend?   Lamoni - May   Independence - December*
      *Only option for Bachelor of Science in Nursing, Health Care Management, and all Master or Doctoral degree candidates. All other candidates may choose to attend either Independence - December or Lamoni - May.

Mailing Address for your diploma:




Teacher Education:
Combination (K-12)
Secondary (7-12)
Elementary (K-6)

Teaching Subject Areas:

Name of Academic Adviser: