OFFICE OF THE REGISTRAR
Brown Hall, Suite 307
A
SSOCIATE
D
EGREE
A
PPLICATION FOR
D
IPLOMA
Student ID Number
Date
Name Enrolled Under (Last, First, Middle, Other)
Phone Number
Address (Street, City, Zip)
Email address
Student Signature
This form is used to order your diploma.
The diploma will be mailed to the address provided the last week of August.
Please fill in the following information accurately and legibly.
PRINT YOUR NAME EXACTLY AS YOU WANT IT TO APPEAR ON YOUR DIPLOMA
:
(Upper and lower case letters please - no special characters)
You can submit this application for diploma by:
Mail—
Arkansas Tech University
Office of the Registrar
Brown Hall, Suite 307
105 West O Street
Russellville, AR 72801-2222
Fax—
479-968-0683
Email—
graduation@atu.edu
Revised June 24, 2020
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