Fillable Form Otr179 - Fedex Diploma Delivery Request printable pdf download

FedEx DIPLOMA DELIVERY REQUEST

RETURN FORM:

BY MAIL TO:

DIRECTIONS—

Diplomas

Complete this form if you wish to have your original diploma

160 Williamson Hall, 231 Pillsbury Dr.

delivered by FedEx. If this form is not completed, your diploma will be mailed by USPS first-class

SE, Minneapolis, MN 55455

mail to U.S. addresses and by USPS airmail to international addresses. If you will be working or

IN PERSON ON CAMPUS AT:

continuing your studies abroad and this diploma will require an Apostille, please contact the Office

160 Williamson Hall

of the Registrar at 612-624-9720.

BY FAX (IF PAYING BY

CREDIT CARD)

Deadline to submit the form—The 15th day of the month following your

612-625-4351

graduation date (e.g., if you graduate in May, this form must be received by June 15). If your form is

received after your diploma has been mailed, the form and payment will be returned to you.

Do not use this form to order a duplicate/replacement diploma. The duplicate diploma order form can be found at policy.umn.edu/forms/

otr/otr178.pdf. Diplomas are available no sooner than six (6) weeks after the end of your term or month of graduation. Your diploma will not

be released if you have outstanding financial obligations to the University.

To ensure privacy online, open in Adobe Reader (free at ). Please add the required signature(s) in blue or black ink.

SECTION 1. Student information

First

Middle

Last

Daytime phone number

Email address

Date of birth

University ID or SSN

Student signature (required)

Date

SECTION 2. Diploma mailing information

Diploma mailing address (line 1; no P.O. Boxes)

Recipient name

Diploma mailing address (line 2)

City

State

ZIP code

Country

Recipient’s daytime phone number (required for Priority Overnight or International Priority deliveries)

PART A. Diploma #1

College

Degree

Graduation date

PART B. Diploma #2 (If earning more than one degree or certificate this term)

College

Degree

Graduation date

SECTION 3. Order summary

Delivery method

Cost

Total

Priority Overnight (Next-business-day delivery by 3 p.m. to most U.S. addresses; recipient phone

$15 delivery fee for each address

number is required and this method cannot be made to P.O. boxes.)

International Priority: (2-5 business day delivery time; recipient phone number is required and this

$25 delivery fee for each address

method cannot be made to P.O. boxes.)

Total amount due:

SECTION 4. Payment information

Requests will not be processed without payment. Send check or money order payable to the University of Minnesota, or provide credit card information

(Visa, MasterCard, Discover, Diner’s Club, AmEx) with card number and expiration date. NOTE: Overpayments of $5.00 or less will not be refunded.

Check one method of payment

Amount enclosed

Cash (in-person orders only)

$________________

Check or money order payable to the University of Minnesota

$________________

Visa

MasterCard

Diner’s Club

Discover Card

AmEx

$________________

__ __ __ __ / __ __ __ __ / __ __ __ __ / __ __ __ __

__ __ / __ __

Account #

Expiration date

To request copies of this form in an alternative format, please call a Disability Resource Center liaison at

*OTR179*

612-625- 9578. The University of Minnesota is an equal opportunity employer and educator. This form is

printed on paper made from no less than 20 percent post-consumer waste.

Please recycle.

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Form Otr179 - Fedex Diploma Delivery Request

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