Please fill in all fields that apply to you.
*****Form will not submit without selecting your department graduating from and your advisor. Must fill out all fields or the form will not submit*****
Student Email Address:
Please select your Major/Program you are Graduating From: Please select an item. ------------------------ Bachelor of Nursing Associate of Arts Associate of Science Business Management Technology Business Management - Accounting Option Business Management - Agri Business Business Management - Cosmetology Business Management - Human Resource Management Business Management - Marketing Media Business Management - Real Estate Business Management - Supply Chain/Logistics Management Office Administration Technology Office Administration Technology - Medical Computer Information Technology - Cyber Security and Networking Computer Information Technology - Software Development Electrical Engineering Technology Electrical Engineering Technology - Alternative Energy Option Smart Manufacturing Technology Mechanical Engineering Technology Robotics and Automation Engineering Technology Criminal Justice Technology Criminal Justice Technology - Probation Officer Social Work and Addictions Technology Law Enforcement Diagnostic Medical Sonography Technology Health Information Technology Medical Laboratory Technology Nursing Technology Occupational Therapy Assistant Technology Physical Therapist Assistant Technology Radiologic Technology Medical Assistant Technology Surgical Technology ** MUST MAKE A SELECTION OR FORM WILL RETURN AN ERROR
Graduating Term: Fall Summer Spring
Graduating Year: 2023 2022 2024
Please Select your Advisor: -------------------------------------------------------------------------------- Elizabeth Azhikannickal Cindy Bachus Stacie Campbell Jared Claytor Cathy Crum Christy Culver Christine Drath Laura Emerick Trish Frazzini Stacie Groll Kaley Haas Ellie Hess Natalie Hess Chad Hensel Cindy Hohman Lori Hosack Feng Hua Lillie Kirsch Mandy Knight Josh Line Lori Makilagi Taylor Merritt Cal Morris Debra Myers Rodney Niese Maureen Pace Brandy Page Greg Perry Emily Rice Amanda Robinson Angie Romich Lisa Schofield Joan Smalley Peggy Smith Tim Stahle Caitlin Stansbery Kristy Taylor Sandy Vent Mike White Carey Wolf ** MUST MAKE A SELECTION OR FORM WILL RETURN AN ERROR
Please select an item.
Will you participate in the May graduation ceremony? Yes No If no, please mail my diploma to the address listed below:
Are you now or have ever been a member of the armed forces of the United States? Yes No
Do you require any ADA special arrangements? If yes, do you require any ADA special arrangements? (Such as a wheelchair or interpreter) Yes No Please Explain:
Telephone Number:
Birth Date:
Name: (As you want it to appear on your diploma!)
First Name
Middle Name
Last Name
Street Address
City
State OH AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OK OR PW PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY
Zip code
County 01 ADAMS 02 ALLEN 03 ASHLAND 04 ASHTABULA 05 ATHENS 06 AUGLAIZE 07 BELMONT 08 BROWN 09 BUTLER 10 CARROLL 11 CHAMPAIGN 12 CLARK 13 CLERMONT 14 CLINTON 15 COLUMBIANA 16 COSHOCTON 17 CRAWFORD 18 CUYAHOGA 19 DARKE 20 DEFIANCE 21 DELAWARE 22 ERIE 23 FAIRFIELD 24 FAYETTE 25 FRANKLIN 26 FULTON 27 GALLIA 28 GEAUGA 29 GREENE 30 GUERNSEY 31 HAMILTON 32 HANCOCK 33 HARDIN 34 HARRISON 35 HENRY 36 HIGHLAND 37 HOCKING 38 HOLMES 39 HURON 40 JACKSON 41 JEFFERSON 42 KNOX 43 LAKE 44 LAWRENCE 45 LICKING 46 LOGAN 47 LORAIN 48 LUCAS 49 MADISON 50 MAHONING 51 MARION 52 MEDINA 53 MEIGS 54 MERCER 55 MIAMI 56 MONROE 57 MONTGOMERY 58 MORGAN 59 MORROW 60 MUSKINGUM 61 NOBLE 62 OTTAWA 63 PAULDING 64 PERRY 65 PICKAWAY 66 PIKE 67 PORTAGE 68 PREBLE 69 PUTNAM 70 RICHLAND 71 ROSS 72 SANDUSKY 73 SCIOTO 74 SENECA 75 SHELBY 76 STARK 77 SUMMIT 78 TRUMBULL 79 TUSCARAWAS 80 UNION 81 VAN WERT 82 VINTON 83 WARREN 84 WASHINGTON 85 WAYNE 86 WILLIAMS 87 WOOD 88 WYANDOT
Check here if this is a new address
Please select the Department your major is in. EXAMPLE if graduating from nursing please select nursing as your department. -------------------- Arts and Sciences Business Technologies Criminal Justice Diagnostic Medical Sonography Engineering Technologies Human and Social Services Health Information Technologies Information Technologies Medical Assistant Medical Laboratory Nursing OTA PTA RAD Respiratory Therapy Surgical Technology ** MUST MAKE A SELECTION OR FORM WILL RETURN AN ERROR
If you are applying for a dual degree you will have to fill out another petition to graduate form.
College Registrar, Marion Technical College 1467 Mount Vernon Avenue Marion, OH 43302-5694 Phone: 740.389.4636 Fax: 740.389.6136 registrar@mtc.edu