2010/11 Intent to Graduate Form

All students who intend to graduate must complete and return this form to the Director
of Student Records no later than Monday, October 11, 2010. This form can be mailed,
faxed (773.256.3007), or emailed from your Meadville.edu email account.
Please PRINT your full legal name as used by Meadville Lombard Theological School.
This is how it will be printed on your diploma and in the Commencement program.
Name: _________________________________________________________________

Degree Expected: ________________________________________________________

Post Graduation E-mail:____________________________________________________

Home Phone: ______________________ Cell Phone: ____________________________

Post Graduation Address: __________________________________________________

________________________________________________________________________

Signature: _______________________________________ Date: ______________

________________________________________________________________________
I have Federal Student Loans ____Yes ___No (If yes, you will receive information in the Spring
regarding the required Stafford and/or Grad PLUS Exit Interview.)
________________________________________________________________________
I plan to go into ministerial search during the 2010/11 Academic Year. By
checking this box, I permit MLTS to share my contact information with the UUA.
________________________________________________________________________
All graduating students must gain graduation clearance from Student Records, the
Business Office and the Library. In April the Director of Student Records will direct this
form to the Business Office and Library for clearance.

FOR OFFICE USE ONLY

Student Records Clearance: Date: _________________ Initials: ________________
Business Office Clearance: Date: _________________ Initials: ________________
Library Clearance: Date: _________________ Initials: ________________
Financial Aid Clearance Date: _________________ Initials: ________________

NOTE: Please remember that the Commencement Ceremony is a celebration and not the same as
completing your degree requirements Your diploma will not be mailed to you until all course
requirements for your program of study AND the financial aid exit interview (if applicable) are satisfied.
All official communication regarding graduation requirements and commencement will be sent to your
Meadville.edu email account.

Updated 9/28/2010 Page 1 of 2

 Intent to Graduate Form
2010/11

ALUMNI/AE INFORMATION REQUEST

Name & Title as you would want it to appear in Alumni/ae publications:

Dr. Rev. Mr. Mrs. Ms. (circle)

Name: _________________________________________________________________

Personal E-mail: __________________________________________________________

Home Phone: ______________________ Cell Phone: ____________________________

Permanent Address: ______________________________________________________

______________________________________________________

Scholarships, Honors, Awards: _______________________________________________

________________________________________________________________________

Student Activities: ________________________________________________________

________________________________________________________________________

Updated 9/28/2010 Page 2 of 2