8/14/2019 Diploma Application (2)-1

1/1

UOPUS-Gr

US/RO 3/25/2009

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 print

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) Name Change (Check if applicable)

FIRST MIDDLE 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 REGISTRARS 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/ZipEMPLOYER INFORMATION

Employer: Job Title:

Employers 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 courtesydegree posted transcript that will be mailed to your home addressseparate 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.

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.

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 take full responsibility for the accuracy and legibility of the information on this form. Should a diploma be ordered incorrectly due to the informationprovided by me, I agree to the cost of $30.00 for reordering my diploma.

X _Students Signature Date Degree

CAMPUS USE ONLY

Total Credits Completed:

Print Name: ____________________

Date: __________ Degree: ________

Campus: _______________________

Tuition and ALL fees paid:

Print Name:_____________________

Date: __________________________

REGISTRARS OFFICE USE ONLY

DATE REQUIREMENTS COMPLETED: _______/ _______/ _______ DATE TO APPEAR ON DIPLOMA: ______/_______/ _______

DIPLOMA ORDERED ON: _______/ _______/ _______ CAMPUS: _______________________ DEGREE: ___________________________