Petition for Program Completion
*optional fields
First Name:
Last Name:
Address:
City:
State
ZIP:
Email Address:
 
Phone Number:
 
Alternate Phone Number*:
Degree Petitioned:
Graduation Fee = $210
Fee Payment Method:
Name as it should appear on diploma:
Semester in which requirements will be completed:
Anticipated last program requirements:
Concentration*:
For Psy.D. and M.A. Thesis Students Only
Dissertation or thesis title*:
Note: This title will be printed in the commencement program.
 
Chairperson for dissertation or thesis*:
Other chairperson*:
Will you attend the commencement ceremony?
Friday, June 13, 2008
Civic Opera House, 20 North Wacker Drive, Chicago, IL		 Yes
No

Number of tickets requested?
Note: Additional tickets will be made available if space allows
Will YOU require any accommodations such as a stage ramp for wheelchair or sign language interpreter?
Note: You will be contacted for details if you answer “yes”.		 Yes
No
Phonetic spelling of your name for pronunciation
(if necessary)?
Example: The phonetic spelling of Joaquin Knightley would be Wa-keen Nightley
Height with shoes for gown measurement:
Weight range for gown measurement:
Electronic Signature and Submission Disclaimer
I certify all information provided is correct to the best of my knowledge. I understand my account will be charged the appropriate graduation fee. I acknowledge that I must complete all degree requirements by July 2008 if I wish to participate in the June 2008 Commencement ceremony.