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