California State University, Northridge A&R
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Have you previously applied for your Master's Degree at CSUN? Yes No |
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Student ID # |
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Anticipated date of graduation |
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Social Security # |
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Date of birth |
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A) Print Name as it appears on official CSUN Records. If you wish to change your name prior to graduation, an official Change of Name form must be submitted to the Office of Admissions and Records.
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Middle |
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| Street | Apt. # |
Phone |
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Zip |
B) Print Name as you wish it to appear on your diploma. Note: Last name must be the same as your name on record (above). First and middle names may vary only in length (i.e., if an initial appears as your first or middle name on record, you may use your full name for diploma purposes; nicknames are not printed on diplomas).
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Do you want your name to appear in the Commencement Program? Yes No
Applicant's Signature ___________________________ Date _________________
Note: This form is not to be used as a change of name form. Please file appropriate Name Change form with the Office of Admissions and Records. If all graduation requirements are not completed by the anticipated date of graduation stated above, you must officially change your date of graduation and pay the required fee in the Office of Admissions and Records.
Print, sign and send to California State University, University Cash Services, 18111 Nordhoff Street, Northridge, CA 91330-8214 with $47.00 check made payable to 'CSUN'.
For official use:
Degree Status _________________ Diploma Pick-up Date _________________
Distinction None 4 Signature _________________