This form should be submitted at least 2 quarters prior to the quarter in which the degree is to be completed. Should you need any assistance in filling out this form, you may contact Laurie Mayhew, Asst. Registrar, at 614/823-1249 or by e-mail at lmayhew@otterbein.edu. You may also fill out the pdf version of this form and fax it to Laurie at 614/823-1009.

First name:
Middle name:
Last name:

Student ID #: (your CardinalWeb ID number, not your social security number)

SMC or mailing address where the degree audit should be mailed. Undergraduate students with a SMC box should list their box number. All other students need to submit a full mailing address.
SMC box:
OR
Home address

Street:
City:
State:	Zip:

Daytime phone number:

Have you previously completed an undergraduate degree?
Yes No

If yes, what type of degree did you complete?

If you are going by a catalog other than the one that was in force when you first began at Otterbein, which catalog should be used when doing your degree audit? (i.e., catalog for 01-03)

Graduation Date:

end of Summer Session

end of Autumn Quarter

end of Winter Quarter

end of Spring Quarter

end of December Term*

Year

*Note: those completing degrees at the end of December Term will be considered end of Winter Quarter graduates.

Type of first degree for which you are applying:

Type of second degree for which you are applying, if applicable:

For this section you will need to access one of the following pdf documents: Undergraduate Majors and Concentrations, or Graduate Majors and Concentrations for your major(s) and the letter code.

Major 1		Concentration(s)
Major 2		Concentration(s)

Undergraduate Applicants Only:
Please use this pdf document of undergraduate minors to enter the 4-digit code of your minor(s).
Minor 1 Minor 2 Minor 3

Complete this section ONLY if you are seeking teacher licensure.
I am Degree seeking Post-baacalaureate

Indicate which Education Booklet you are using:
Red Booklet (2000)
Blue Booklet (2001)
Beige Booklet (2002)
Yellow Booklet (2003)
Other. Indicate color and year .

Use this pdf file to find the code (in blue) for your Teacher Licensure, Nursing Certification or Reading Endorsement Areas and enter it below.
Teaching field 1 Grade level
Teaching field 2 Grade level

Is there anything else we need to know?