Return this form immediately to avoid delays in your graduation

PARTNER:

APPLICATION TO GRADUATE
STUDENT NUMBER:

TITLE:

Mr

Mrs

Miss

Ms

Please write your names below, exactly as you wish them to be written on your testamur.
(Use upper and lower case letters eg. Wei Yang)

LAST (FAMILY) NAME:

...........................................................................................................................................................................................

FIRST NAMES (in full):

...........................................................................................................................................................................................

First names will precede the family name on your testamur. If you are from a culture where the family name precedes the first name,
please indicate below the exact order in which your name is to appear on your testamur (eg Yang Wei):

FORMAL NAME:

..............................................................................................................................................................................................................
(Formal order of your name to be printed on your testamur)

MAILING ADDRESS:

(This address will be used to forward your testamur if you choose box 2 below)

Street Number and Name: ..........................................................................................................................................................................................................

Suburb or Town: ................................................................................................
Postcode: ............................................................................................
Home phone: + .......................................................

State or Province: ..................................................................................

Country: .........................................................................................................

Work phone: + ........................................................

Mobile: ............................................................

E-mail Address: ...........................................................................................................................................................................................................................

TITLE of AWARD:

Having successfully completed all requirements of the award of:

..........................................................................................................................................................................................................................................................
(Title of Award)
I hereby make application for admission to the award as indicated below (tick box 1 or 2 as appropriate):
1.

I wish to attend a Graduation Ceremony in Australia in:

Gold Coast Southern Cross Business School 19 May 2012

Lismore

Coffs Harbour

31 March 2012

Sydney
Lismore

21 April 2012
4 & 5 May 2012

15 September 2012

The Student Graduation Officer will email you when further information is available.

OR
2.

I wish to receive my testamur (award) via mail.

I waive my right to attend a Graduation Ceremony.
I would like my testamur posted to me after the conferral date (the date your testamur is awarded).

Signature:

...................................................................................................

Date:

.................. / ................ /.................

Please return completed form in one of the following ways :

By mail:
Attention: Student Graduation Officer
Rod Treyvaud Building
Southern Cross University
PO Box 157
LISMORE NSW 2480
AUSTRALIA

By fax:

By e-mail:

+61 2 6620 3692

studentgradinfo@scu.edu.au

Important Notice: The University reserves the right to cancel ceremonies due to low attendance rates, or for any other reason. In the event of
a cancellation, the University will notify all graduands in writing.
CRICOS Provider Nos: 01241G (NSW), 02621K (WA), 03135E (QLD)