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                                                                                                                       FOR TERM/YEAR
                                  Declaration of Intent
                                  to Receive a Degree/Certificate
                                  Registrar’s Office
                                  160 East Tenth Street, Claremont, CA 91711 • Ph. (909) 621-8285 • Fax (909) 607-7285 • student.records@cgu.edu


Student Information: Print your name as it is recorded on your official CGU student record. If you need to file an official name change, please submit a
Change of Name or Address Form to the Registrar’s Office.

Last Name          _______                                                                     First Name                                     Middle Name ________________

CGU ID #254 -                                   _______________________________ E-Mail ______________________________________________@ cgu.edu

Date of Birth (MM/DD/YYYY) ________________________________________ Phone (__________)_______________________________________


You must declare your intent to receive a degree/certificate by the deadline for the semester in which you expect to graduate.
This deadline is announced in the Academic Calendar. Forms must be submitted to the Registrar’s Office by this date.

•     Upon receipt of this form, you are placed on a preliminary degree list and a preliminary degree-posting transaction appears on your transcript.
•     You must complete your degree requirements by the deadline announced in the Academic Calendar. If you do not complete your degree requirements, you are
      removed from the degree list. To graduate in a subsequent semester, you must submit a new Intent form for the next semester you expect to graduate.
•     Commencement information is distributed during the Spring semester to all candidates who expect to graduate in the Spring semester as well as to all degree
      recipients from the previous Summer and Fall semesters.
•     For Doctoral Students
      ♦       International The day you submit your dissertation is considered the last day of your academic program as it relates to your SEVIS program end date.
      ♦       Domestic Your last date of enrollment as it relates to loan repayment is equal to the last date of the last semester in which you enrolled, regardless of
              the date you submit your dissertation.
•     For Master’s Students
      Degrees are posted when all final grades have been submitted by your instructors. Students continuing into a new CGU program should not be impacted.


Enter your expected graduation term in the TERM/YEAR box at the top of this form and check all of the following that apply.
                I am a certificate only student.                                                             I am an interfield student.
                I am certificate student who is also completing a degree.                                    This is my final degree and I will be departing from CGU.
                I am receiving this master’s degree along the way to my PhD.*                                I plan to begin a subsequent degree at CGU and have filed a
                I am a dual degree student.*                                                                 Changing to a New Degree form.*
                          * Note: Please refer to the CGU Bulletin for policies on degrees and sharing units. Units may only be shared by a maximum of two degrees.



I intend to complete the following degree/certificate this semester: (Submit separate forms for each degree/certificate.)


Academic Department ______________________________________________________________________________________________________
                                                (Management, Cultural Studies, Psychology, Religion, Teacher Education, etc…)

Degree or Certificate ________________________________________________________________________________________________________
                                     (ex: Ph.D. in Religion / Ph.D. in Psychology / MS in Mathematics / MA in International Studies / etc…)


Student Signature _____________________________________________________________ Date _______________________________



                        COMMENCEMENT CEREMONY                                                                   MAILING ADDRESS FOR YOUR DIPLOMA
For student receiving degrees in Summer and Fall, would you like to participate in                         Indicate the address where you would like your diploma sent.
the subsequent Spring’s Commencement Ceremony?
           Yes         No
                                                                                                        Check here to update your student record with this mailing address,
                                                                                                  If your address changes again after the end of this semester, please notify us.
We will mail a packet of information about the ceremony to you prior to the event.

Additionally, please provide phonetic guidelines for pronouncing your name.

First Name:

Middle Name:

Last Name:


For Office Use
Received:       Posted:     Notes:
                                                                                                                                                                        CF 510 Rev 2/10
                                                                                 Student Exit/Degree Completion Survey
                                 The following survey includes questions concerning your experience at CGU, your academic training, student
                                 services, campus climate and your plans after receiving your degree. This information is used to assess and
                                 improve the graduate programs and student services. Please fill in circles completely.

                                 All responses will remain confidential and used in aggregate only.

A.    Satisfaction with CGU/departments/services

Please indicate your level of agreement or disagreement with each of the following statements.

                                                                                                            Strongly                                     Strongly
                                                                                                            Disagree    Disagree   Neutral   Agree        Agree     NA

1.    I am pleased that I chose to do my graduate study at CGU.

2.    The courses I took were valuable for my intended profession.

3.    The quality of academic advising was high.

4.    The quality of supervision by my dissertation chair was high.

5.    Faculty were supportive of my academic interests.

6.    I had the opportunity to develop a mentoring relationship with a faculty member.

7.    I received useful feedback from faculty on my class performance.

8.    Students in my department were treated with respect.

9.    I was encouraged to participate in professional development opportunities by my department.

10.   I had the opportunity to develop teaching skills.

11.   I had the opportunity to develop research skills.

12.   I had the opportunity to develop grant/proposal writing skills.

13.   Training in academic issues related to diversity has influenced my scholarship.

14.   The courses in my department included topics related to diversity (cultural, ethnic, or gender).

15.   I feel well prepared by CGU for the next phase of my career.

16.   Overall, I am satisfied with my department.

17.   I would recommend CGU to someone who was thinking about graduate study.


Please indicate your level of satisfaction or dissatisfaction with the following services at CGU.

                                                     Very                                                    Very       Did Not
                                                  Dissatisfied    Dissatisfied    Neutral       Satisfied   Satisfied    Use

18.   Admissions Office

19.   Career Management Center

20.   Computer Support/Help Desk

21.   Financial Aid Office

22.   Minority Mentor Program

23.   Preparing Future Faculty Program

24.   Registrar’s Office

25.   Writing Center


B.    Academics, while at CGU
                                                                                                  Zero         1           2          3              4        5 or more

26.   How many academic conferences did you attend?

27.   How many papers have you PRESENTED at professional conferences?

28.   How many papers have you SUBMITTED for publication?

29.   Of those papers, how many were accepted for PUBLICATION?
                                                                            Yes           No

30.   Is your thesis or dissertation transdisciplinary?




31.   What was THE major challenge to
      completing your thesis/dissertation?




32.   What was THE major challenge to
      completing your coursework?




C.    Future plans and past employment
                                                                                                           Yes               No (go to question 36)
33.   Do you have DEFINITE plans for continued study or employment after graduation?



                                                                           Prof.         Post Doc.
                                                           PhD          Degree/Cert      Education        Other         No Plans
34.   What are your plans for continued study?


35.   What are your plans for employment?
                                                          Tenure        Non-Tenure       Instructor/     Admin.
                                                          Track           Track           Adjunct         Appt.        No Plans
               a.   Academic Employment

                                                          Private                          Non-
                                                          Sector        Public Sector      Profit        No Plans
               b.   Other Employment


                                                                            Yes           No (go to question 38)

36.   During the past twelve months, were you employed?

                                                                               Less     11 to 20       21 to 30       31 to 40        More
                                                                             than 11                                                 than 40

37.   How many hours a week did you typically work?




D. Harassment and Discrimination
HARASSMENT is uninvited and unwelcome verbal or physical conduct, comment or display that demeans, belittles, intimidates or
humiliates another person or group.

Have you personally experienced or witnessed harassment (as defined above) at Claremont Graduate University in the current
academic year? If you have, please indicate which type(s), otherwise select “did not experience or witness.”

38.   Type of harassment personally experienced. (Mark all that apply)

    Did not                                                                                                                                            Sexual
  experience               Age               Disability             National Origin     Race/ethnicity            Religion             Gender         Orientation   Other



39.   Type of harassment witnessed. (Mark all that apply)
                                                                                                                                                       Sexual
Did not witness            Age               Disabiity              National Origin     Race/ethnicity            Religion             Gender         Orientation   Other
DISCRIMINATION is the unfair and unequal treatment or consideration of a person or group on the basis of class, category, partiality
or prejudice.

Have you personally experienced or witnessed discrimination (as defined above) at Claremont Graduate University in the current
academic year? If you have, please indicate which type(s), otherwise select “did not experience or witness.”

40.   Type of discrimination personally experienced. (Mark all that apply)

    Did not                                                                                                                                       Sexual
  experience                Age                    Disability        National Origin    Race/ethnicity         Religion          Gender          Orientation          Other



41.   Type of discrimination witnessed. (Mark all that apply)
                                                                                                                                                  Sexual
Did not witness             Age                    Disability        National Origin    Race/ethnicity         Religion          Gender          Orientation          Other



E.    Finances
42.   Which type of funding did you receive during your studies? (Mark all that apply)

               CGU                Outside
            Scholarship/        Scholarship/                            Research       Administrative     Teaching         Corporate       Tuition
Loans        Fellowship          Fellowship             Grants         Assistantship   Assistantship     Assistantship    Sponsorship     Remission       Other    Other (specify)



For questions 43 and 44, please write each digit of the number on each line. If not using the interactive form, please also circle the
corresponding number beneath each digit.
43.   BEFORE you first enrolled at CGU, what was total amount of                                         44.   WHILE enrolled at CGU, how much NEW educational debt have you
      educational loans you acquired (in thousands or dollars)?                                                acquired (in thousands of dollars, excluding prior loans)?
      $                                                   ,000.00                                               $                                        ,000.00
           0                0                  0                                                                     0             0             0
           1                1                  1                                                                     1             1             1
           2                2                  2                                                                     2             2             2
           3                3                  3                                                                     3             3             3
           4                4                  4                                                                     4             4             4
           5                5                  5                                                                     5             5             5
           6                6                  6                                                                     6             6             6
           7                7                  7                                                                     7             7             7
           8                8                  8                                                                     8             8             8
           9                9                  9                                                                     9             9             9

F.    Demographics

45.   Which of the following best describes your student status while:
                                                                                  Full Time       Part Time         FT and PT   Not Applicable
                       a.       Taking classes?

                       b.       Writing your dissertation or thesis?



                                                                 1           2            3              4          5 or more

46.   How many years were you in the program
      you are applying to receive a degree in?


                                                                                   Master’s       Doctorate           Dual        Certificate         Credential

47.   Which degree are you currently applying to receive?
48.   Which program is the degree you are currently applying to receive in? (mark all that apply)


         Applied Women’s Studies                               Financial Engineering                                   Politics and Policy

         Art                                                   Health Information Management                           Politics, Economics, and Business

         Arts Management                                       History                                                 Psychology

         Botany                                                Human Resources Design                                  Psychology

         Cultural Studies                                      Information Systems and Technology                      Public Health

         Economics                                             Management                                              Public Policy and Evaluation

         Education                                             Mathematics                                             Religion

         English                                               Music                                                   Teacher Education

         Executive Management                                  Philosophy                                              Other

                                           Female           Male
49.   What is your gender?
                                         US Citizen      Perm. Res.          International   If International, from which country? (go to question 52)

50.   What is your residency status?

                                           American Indian/       African                                           Pacific Islander/
                                            Alaskan Native       American            Asian      Latino/Latina         Hawaiian               White    Multi-racial   Other
51.   What is your racial background?

52.   Strictly for survey tracking purposes, please provide the six middle digits of your student ID number. ID’s will be stripped from the data once the data has been compiled
      to ensure anonymity. If not using the interactive form, please also circle the corresponding number beneath each digit.
                                               254 -                                                                              -0
                                                           0             0             0          0             0          0
                                                           1             1             1          1             1          1
                                                           2             2             2          2             2          2
                                                           3             3             3          3             3          3
                                                           4             4             4          4             4          4
                                                           5             5             5          5             5          5
                                                           6             6             6          6             6          6
                                                           7             7             7          7             7          7
                                                           8             8             8          8             8          8
                                                           9             9             9          9             9          9

53.   Please share any suggestions or comments you might have. Use additional paper if necessary.




                   Thank you for completing this survey. All responses will remain confidential and used in the aggregate only.
                                             Drucker-Ito students- Please continue on to next page
                                                                    Drucker/Ito Graduates Only
                                The following questions are important for the Drucker/Ito School and for Career Services. Only Drucker/Ito
                                graduates are requested to complete this page.

                                 All information will remain confidential and be used in the aggregate only.


D1.   What was your undergraduate major?                                      ANSWER THE FOLLOWING ONLY IF YOU HAVE ACCEPTED A JOB OFFER.
       Business
       Technical                                                              D14.     What company did you accept a job offer from?
       Other (specify)                                                        Company Name                                 Country (if outside of USA)

D2.   How much professional experience do you have?
       1 year or less
       More than 1 year, but less than 3 years                                D15.     What is your primary function?
                                                                                     Marketing/Sales                               Operations/Logistics
       More than 3 years, but less than 5 years
                                                                                     Finance/Accounting                            General Management
       More than 5 years
                                                                                     Consulting                                    Human Resources
                                                              Yes   No   NA
                                                                                     MIS                                           Other (specify)
D3.   Do you plan on starting your own business
      within the next 10 years?

                                                           Yes      No   NA
                                                                              D16.     What is your primary industry?
D4.   Did you do an internship while in your program?
                                                                                     Manufacturing                                 Financial Services
D5.   Did you want to do an internship while in your
                                                                                     Government                                    Consulting Services
      program?
                                                                                     Not-for-Profit                                Other (specify)
D6.   Did you get any assistance from CGU to find an
      internship?


D7.   What is your employment status?
                                                                              D17.     If you had an internship, is your full-time job with your intern company?
       I am company-sponsored or already employed
                                                                                     Yes, and my internship was school facilitated
       I am starting a new business as owner
                                                                                     Yes, and my internship was student facilitated
       I have been seeking employment (go to question D13)
                                                                                     No
       I have postponed my job search (stop here)

       Other (specify)                                                        D18.     What is the primary source of the job you accepted?
                                                                                     School facilitated source
While in the program did you:
                                                           Yes      No   NA          Student facilitated source

D8. Transition to another role in your organization?
                                                                              Salary information in US Dollars
D9. Find a new job?                                                            Benefits or perquisites such as cars, equipment, memberships, stock options, and
                                                                               moving services are not equated and are not included in any compensation category.
D10. Get a promotion?
                                                                              D19.    Annual base salary for your job:                     US$
D11.   What was your annual base salary before you         US$                           Excludes bonuses, commissions, and any other
       started your program?                                                             compensation

D12.   What is your annual base salary now leaving
       the program?
                                                           US$                D20.    Signing bonus:                                       US$


IF YOU DID NOT SEEK EMPLOYMENT, STOP HERE.

D13.     What is your job seeking status?                                     D21.    Other compensation:                                  US$
       Offer received but declined or do not plan to accept                              Other taxable payroll compensation such as
                                                                                         guaranteed annual bonus and guaranteed
       Holding an offer(s), but have not made a decision                                 overtime.
       Have accepted an offer
       Have not received an offer and I am still seeking
                                                                                                                   Thank you.
       Other (specify)                                                                                Your responses will remain confidential
                                                                                                        and only reported in the aggregate.

				
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