CCC Graduation Application

Asterisk (*) indicates a response is required.

You should complete and submit this form at least one semester prior to the semester in which you will be completing your graduation requirements. Once you complete the form, the results will be emailed to the Registrar's Office and a copy will be sent to the email address you provide below.

DISCLAIMER: Appearance of your name in the CCC program or participation in the ceremony is not official evidence of degree completion.

Please consult an academic advisor in Student Services, or the Registrar, prior to adding or dropping classes after you apply for graduation. Failure to do so may result in delaying your graduation.

*First Name:
*Middle Name:
*Last Name:
*Phone Number:
*Student ID:
*Address:
*City:
*State:
*Zip:
*E-mail:

Anticipated Completion Date

*CCC holds one Commencement Ceremony for all participating graduates. The Commencement Ceremony will be held May at Clinton High School Yourd Gymnasium. There is NO CHARGE to participate. Watch EICC Connect for more details.

*Those who apply for Fall Graduation would participate in our May graduation ceremony.

*Semester: Fall Spring Summer
*Year:

Degree which you are applying for:

*Award type:

Associate in Arts Degree

Associate in Science Degree

Associate in Applied Science Degree

Diploma

Certificate
If AAS, Diploma or Certificate, please choose from the programs list below:

Commencement

We hold one Commencement Ceremony in May for all graduates, Fall, Spring, and Summer. Your attendance is encouraged for this great celebration of your accomplishment.

*Do you plan to participate in the ceremony? Yes No

If yes, please enter the following for cap and gown order:
*Height:
*T-Shirt Size:
*Weight:
*If attending, please enter the phonetic spelling of your name:
*Phi Theta Kappa Member? Yes No
*Veteran/Military Service? Yes No
*Do you have any transfer work? Yes No
*If yes, please provide the name of the college/university:
Please separate multiple college names with commas.
*Will you need special accommodations for the ceremony? If so, how may we assist?

*Application approval is contingent upon successful completion of courses to be used to meet degree requirements. If your application for degree is not approved for the date listed, you must re-apply for the degree as of whatever subsequent date is appropriate. Your submission of this form and acknowledgement serves as your electronic signature for this course request.

It is the policy of Eastern Iowa Community College District not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual orientation, gender identity, creed, religion, and actual or potential family, parental or marital status, as required by the Iowa Code §§216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681-1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact EICC’s Equal Employment Opportunity Officer/Equity Coordinator, Eastern Iowa Community College District, 101 West Third Street, Davenport, Iowa 52801, 563-336-5222, equity@eicc.edu or the Director of the Office for Civil Rights U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204, Telephone: (312) 730-1560 Facsimile: (312) 730- 1576, TDD (800) 877-8339 OCR.Chicago@ed.gov.