Diploma Application (2)-1

UOPUS-GradApp

DIPLOMA APPLICATION A Diploma Application must be submitted in order for a degree to be conferred and for a diploma with a degree-posted transcript to be printed. Please allow at least 30 business days to process your degree.

NAME (AS CONSISTENT WITH YOUR OFFICIAL EDUCATION RECORDS) FIRST

MIDDLE

LAST

IRN

NAME (AS YOU WOULD LIKE IT TO APPEAR ON YOUR DIPLOMA) FIRST

MIDDLE

Name Change (Check if applicable) LAST

If you have had a name change since your application to the University, you must provide the University with legal documentation (such as a court petition, marriage license, or divorce decree) of your new name. Copies must accompany this application if not previously submitted.

PERMANENT ADDRESS (PLEASE COMPLETE IN FULL FOR ALUMNI AND REGISTRAR’S OFFICE PURPOSES) Address Change (Check if different from existing education records)

Please include area code:

Address

Home Phone Number: (

)

City/State/Zip

ADDRESS TO MAIL DIPLOMA Street City/State/Zip

EMPLOYER INFORMATION Employer:

Job Title:

Employer’s Address

Work Phone Number: (

)

ADDITIONAL DIPLOMA OR TRANSCRIPT Additional diploma

… Yes

Quantity ($30.00 each)

Additional transcripts

… Yes

Quantity

Please note that the University will provide you with a courtesy degree posted transcript that will be mailed to your home address separate from your diploma via USPS.

Master of Business Administration (MBA 021) Students Only I have met the requirements and would like to have the following concentration(s) documented on my official transcript. Accounting (ACC)

Energy Management (EM)

Global Management (GM)

Health Care Management (HCM)

Human Resource Management (HRM)

Marketing (MKT)

Project Management (PM)

Small Business Management (SBM)

Technology Management (TM)

I do not want a concentration documented on my transcript The diploma will not reflect the concentration. Concentrations are only reflected on the official transcript. The University will verify concentration eligibility. I take full responsibility for the accuracy and legibility of the information on this form. Should a diploma be ordered incorrectly due to the information provided by me, I agree to the cost of $30.00 for reordering my diploma. X

_ Student’s Signature

Date

Degree

CAMPUS USE ONLY

Total Credits Completed:

Tuition and ALL fees paid:

Print Name: ____________________

Print Name:_____________________

Date: __________ Degree: ________

Date: __________________________

Campus: _______________________

REGISTRAR’S OFFICE USE ONLY DATE REQUIREMENTS COMPLETED: _______/ _______/ _______ DIPLOMA ORDERED ON:

US/RO 3/25/2009

_______/ _______/ _______

DATE TO APPEAR ON DIPLOMA: ______/_______/ _______ CAMPUS: _______________________

DEGREE: ___________________________