UOPUS-GradApp

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 printed.
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 REGISTRAR’S 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/Zip
EMPLOYER INFORMATION

Employer: Job Title:

Employer’s Address Work Phone Number: ( )

ADDITIONAL DIPLOMA OR TRANSCRIPT
Please note that the University will provide you with a courtesy
Additional diploma … Yes Quantity ($30.00 each)
degree posted transcript that will be mailed to your home address
Additional transcripts … Yes Quantity separate 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.
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 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.
I take full responsibility for the accuracy and legibility of the information on this form. Should a diploma be ordered incorrectly due to the information
provided by me, I agree to the cost of $30.00 for reordering my diploma.

X _
Student’s Signature Date Degree
CAMPUS USE ONLY
Total Credits Completed: Tuition and ALL fees paid:
Print Name: ____________________ Print Name:_____________________
Date: __________ Degree: ________
Date: __________________________
Campus: _______________________

REGISTRAR’S OFFICE USE ONLY

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

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

US/RO 3/25/2009