Intent to Graduate Form

Student Information

The name below is your full legal name as used by the College and indicates how it will be printed on your diploma, in the commencement program, and in the newspaper. Please indicate appropriate spaces, hyphens, and upper and lower case letters.

Name*

First Middle Last

Name Change

If your legal name will be changing between now and commencement, please list your new name below.

Date of Birth*

Program*

Expected Graduation Date*

May
October
December

Graduation Year*

Post Graduation Address

Please indicate where all mailings and emails should be sent after graduation. Please note: Please use a non-Bellin College/non-school email address for your answer. Also, if you use your parents' address as your "permanent" address, the USPS may not deliver once you have filled out a "change of address" form. This is at the discretion of each branch.

Post-Graduation Address*

Street Address Address Line 2 City State ZIP Code

Post-Graduation Email Address*

(Non-Bellin College email address please)

Post-Graduation Phone Number*

Commencement Information

Please indicate if you will be participating in the commencement ceremony and how you want your name announced as you walk across stage. If you feel the need, please indicate how you pronounce your name. **If you are not walking during commencement, a cap & gown will not be ordered for you.

Commencement Ceremony Participation*

I will NOT be participating in the commencement ceremony.
I will be participating in the commencement ceremony.

Announcement of your name at commencement:*

(Example: Jane Ann Doe or Jane Doe)

Phonetic pronunciation of your name:

Hometown*

In order to reflect the diversity of our student body, we would like to capture where you are originally from. What do you consider as your “hometown” city and state? This information will be shared with our board of trustees and may be printed in the graduation program. (You will have an opportunity to opt out of certain information below.)

Measuring For A Gown

Height and weight are used to determine the approximate size of your gown.

Height (feet)*

Height (inches, round up if in the middle)*

Weight (LBS)*

Media Release

Various items will be printed for the commencement ceremony. Please indicate if you would like your name released with others as a "List of Graduates" to various media for publication in Green Bay newspapers and other area/hometown newspapers, as well as including your name in the printed program.

Graduation Lists in Media*

Yes, please include my name & hometown in any printed material or news releases to media.
No, please remove my name from any news releases, but please print my information in the program for commencement.
No, please remove my name from any material regarding graduation.

If you would like us to send the news release to your hometown newspaper, please indicate which town/paper.

Diplomas

If there is a different address from the above you would like your diploma sent, please indicate in Line 2 the person to whom it is being sent (i.e. James Doe, father).

Mail my diploma to:

Same address as entered above
Different address than above (enter information below).

Diploma Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Pins (undergraduate students only)

As an undergraduate, you will receive a Bellin College pin when crossing the stage. This pin will have your initials and year of graduation engraved on the back. Please indicate what initials you would like engraved (Example: Jane Marie Doe - JMD)

Initials to Engrave on Pin

Alumni Gift

The Bellin College Alumni Family has a gift for you! Please indicate your t-shirt size below.

Alumni T-Shirt Size

Small
Medium
Large
X-Large
2X-Large

Student Signature

By typing your name in the box below, I hereby declare that the information in this application is complete and accurate to the best of my knowledge.

Signature*

Today's Date*

BC Family

Visitors

BC Family

Visitors