Graduate Clearance Form printable pdf download

Graduate Clearance Form

GRADUATE CLEARANCE FORM

Graduates who fail to collect their diplomas within 3 months after they have been issued by the Records

Department should get clearance from the library and the Business Office and return completed form to Records

in order to collect their diploma.

Graduate’s Name: __________________________________________________________________________

Please Print

UB Student Numbers(s): _____________________________________________________________________

Degree: _______________________________________ Major: _____________________________________

Graduation Date: ___________________________________________________________________________

FOR OFFICIAL USE ONLY

LIBRARY

BUSINESS OFFICE

Date Cleared: ________________________________

Date Cleared: _______________________________

Office Stamp:

Official’s Name: ______________________________

Official’s Name: _____________________________

Official’s Signature: ___________________________

Official’s Signature: __________________________

Comments: __________________________________

Comments: _________________________________

____________________________________________

___________________________________________

RECORDS DEPARTMENT USE ONLY

Date Processed: _____________________

Signature: _______________________________________

Graduate Clearance Form/Records Department/January 2017

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Graduate Clearance Form