This form must be filed with the Registration and Records Office no later than two weeks after the start of the term in which you intend to graduate.

 

*Student ID Number:

 

 

*UW-Stout Email

 Address:

 

 

Name:

 

(Print exactly as you wish to appear on diploma)

Current Address:
Street: Apartment #:
City:

State:

  
Zip Code: Local Phone:

Address for Mailing your Diploma:            

Street:

Apartment #:

City:

State/Country:

  
Zip Code:

If this address changes please call 232-5398   
 
Hometown and State OR State and Country for Commencement listing if different than mailing address 

City/State:

State/Country:

Major:

Concentration:

           Minor:

 (Complete a form for each Major)

 

Please Select Your Anticipated Graduation Date:

 

*Required for Processing