Psychology Commencement 2015

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Instructions

Please complete all of the information on this form. Please note: If you do not submit this form by May 1, you may not be guaranteed a place in our commencement ceremony.

Name (as you would like it read at Commencement):

First Name *

Middle Name

Last Name *

Pronunciation of name (i.e., LEE-land STAN-ford YOU-ni-ver-citee): *

Degree Type: *

Bachelor of Arts

Master of Arts

Doctor of Philosophy

Please check off the following activities and programs in which you’ve participated:

Double-Major

Minor

Senior Honors Program

Track

Co-Term

Black Psychology Students Association (BPSA)

SUPA (Stanford Undergraduate Psychology Association)

If you checked Double-Major, please indicate which one

If you checked Minor, please indicate which one

If you checked Track, please indicate which one

Number of people attending the ceremony and reception: (Please limit your guests to five) *

Please indicate any disability seating/special accommodations you or your guests might need:

Please list any additional information you would like us to know:

Can we release your name, permanent address and email address to our Commencement Photographer? *

Yes

If yes, please indicate the following, Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

In Memoriam

If you would like to honor any family and/or friends who passed away in the In Memoriam section of our Commencement Program, please submit your entry using the following format: (Example: In Memory of John Smith, grandfather of graduate Jane Smith)

Name of deceased

Relationship to you

Your name