Fillable Apostille Request and plan to obtain an Apostille (University of Minnesota)

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Apostille Request and plan to obtain an Apostille (University of Minnesota)

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Apostille Request
OTR005 Last updated: 8/19
Page 1 of 2
Section A. Student information
University ID Birth date (mm/dd/yyyy)
Name (last, first, middle) Name used while attending
Email Phone
Address City State Zip
Section B. Order student records and shipping
Item Quantity Cost Subtotal
Choose
student
records
Diploma
If you request a diploma name that differs significantly from the
name on your records, you must submit documentation. For more
information, contact OTR, 612-626-4432. Indicate your name as
you would like it to appear on your diploma:
$5 each
First Middle
Last
Official transcript $5 each
Verification letter (attach a written statement of what to include in the letter) $5
Shipping
(choose one)
Ship to domestic address via FedEx $30
Ship to international address via FedEx $15
Grand total
Use this form to submit a request to the Ofce of the Registrar (OTR) for the facilitation of obtaining
notarization and Apostille, certicate of ofce, or authentication of your student records. OTR can
send your certied documents to their nal destination.
DO NOT USE THIS FORM if you need to request a diploma, transcripts, or verication letter ONLY,
and plan to obtain an Apostille on your own.
If there are additional documents required by the foreign entity that need to accompany your certied
documents, you must submit them with this form. OTR will send a nal package of documents to the
foreign entity and everything required must be included when you submit your request for Apostille
to OTR.
You must include payment by credit card, cash, or check payable to the University of Minnesota for
your student record documents and shipping costs. Apostille requests will not be processed without
payment.
Use this checklist to ensure you submit the required materials to complete your request:
Payment to University of Minnesota for student record documents and shipping
State of MN Secretary of State Authentication Request form at z.umn.edu/MNSOSauthentication
Written request for verification letter (if applicable)
Any other documentation required by the foreign entity (if applicable)
RETURN THIS FORM
Ofce of the Registrar
University of Minnesota,
Twin Cities
200 Fraser Hall
106 Pleasant St. SE
Minneapolis, MN 55455
otr@umn.edu
Read more information at
z.umn.edu/Apostille
Apostille Request
OTR005 Last updated: 8/19
Page 2 of 2
Student information
Name (last, first, middle) University ID
Section C. Final destination shipping address (final destination after receiving Apostille from MN Sec. of State)
Recipient name Recipient phone (required)
Mailing address (line 1) Mailing address (line 2)
City State ZIP code Country
Section D. Payment option (Overpayments of $5.00 or less will not be refunded.)
Choose a payment method
Amount enclosed
Cash (for in-person orders only)
Check/money order payable to University of Minnesota
Credit card
Visa MasterCard Discover American Express
Card number: _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ Expiration date: _ _ / _ _
SECTION F. SIGNATURE
Name Signature Date
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Apostille Request and plan to obtain an Apostille (University of Minnesota)

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Completed 14 April 2022

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