Revised 09/18/2018
ABSENCE FROM COMMENCEMENT
STUDENT INFORMATION
___ ___ ___ - ___ ___ - ___ ___ ___
CWID
Name:
Personal Email:
Telephone:
Degree
Quarter: Fall Winter Spring Summer
Program Type (Select One)
UNDERGRADUATE DEGREE:________________________________________________________
GRADUATE DEGREE:_______________________________________________________________
Reason for Absence:
PICK-UP / DELIVERY INFORMATION
Please select one of the following options:
I WOULD LIKE MY DIPLOMA(S) MAILED (U.S. addresses only):
Address:___________________________________________________________________________
City:____________________________________________ State__________________ Zip_______
There is a $10.00 fee for postage and handling (available for addresses within the United States only). Payment may be
made by Check or Money Order made payable to Louisiana Tech University and attached to this form. Credit Card
payments may be made by calling the Comptroller’s Office at 318-257-4325. Do NOT send cash. Mailed diplomas and
Pick-Ups will be processed the week following commencement
VALID PHOTO IDENTIFICATION IS REQUIRED AT THE TIME OF PICK-UP.
I WILL PICK-UP MY DIPLOMA(S):
I GIVE MY PERMISSION for the person named below to pick up my diploma(s)
Name of designate:__________________________________________________________
Note: Identification required for release of dipolma.
I am requesting permission to graduate in absentia. I do not plan to participate in the commencement
ceremonies. I understand I am still required to complete the Graduation Application for graduation approval.
Signature: Date:
APPROVED BY:
Office of the University Registrar (Staff Signature) Date
Return completed form to:
Registrar’s Office,
Louisiana Tech University
P.O. Box 3155, Ruston, LA 71272
email: graduation@latech.edu
click to sign
signature
click to edit
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