Fillable Additional Diploma Request Form printable pdf download

Additional Diploma Request Form

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Additional Diploma Request



Diploma Fee: $30.00 per copy; payment must accompany completed request form.



Requests are processed upon verification of the requestor’s degree from Holy Names University.



All holds must be cleared before this request will be processed.



Diploma orders are sent to the printer at the conclusion of each semester; total wait time to receive diploma is three to four months.

Please type or print legibly in ink;



incomplete requests or requests that do not include payment will not be processed.



Questions call: (510) 436-1133 or email

studentresourcecenter@hnu.edu

1. Student ID/SSN: ________________________________

2. Name:

_____________________________________________________________________

3. Address:

_____________________________________________________________________

City:

________________________

State/Country: _____________________

Zip code:

________________________

4. Daytime Phone: (______) _________________

5. Email Address: ________________________________________

6. DIPLOMA NAME:

Please use upper and lower case letters. Your name will appear on your diploma as written.

7. Dates of Attendance: ________________________________________________________

8. Degree Awarded: ____________________________________________________________

9. Student’s Signature: ______________________________________________

Date: ___________________

10. Number of copies requested: ____________ x $30.00 each = $______________

11. Mail or deliver completed request with payment to:

(cashier’s check or money order payable to: Holy Names University)

Holy Names University

Student Resource Center

3500 Mountain Boulevard

Oakland, CA 94619-1627

FOR REGISTRAR’S OFFICE USE ONLY. PLEASE DO NOT WRITE IN THE SPACE BELOW.

Date received: ______/______/______

Balance: Y

N Degree Date: ______/______/______ Degree: ____________________________________

Payment: $______________________

Hold:

Honors:

Date Mailed or Picked Up: ______/_______/______

Signature Required for Pick-Up: ______________________________________________

Form Revised: May 1, 2015

Additional Diploma Request Form

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