Fillable DIPLOMA NAME REQUEST FORM This form is to (California Polytechnic State University, Pomona)

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DIPLOMA NAME REQUEST FORM This form is to (California Polytechnic State University, Pomona)

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CLIFORNIA STATE POLYTECHNIC UNIVERSITY, POMONA
Registrar’s Office
DIPLOMA NAME REQUEST FORM
This form is to be used for the purpose of requesting that the name printed on your Cal Poly Pomona
diploma be different from how your name appears on your official Cal Poly Pomona records.
The f
ollowing are examples of acceptable reasons to use this form:
• Accents or Special Characters (e.g. Nuñez or Lucían)
• Abbreviation of Middle name to an initial
• Errors in spacing and/or upper/lower case lettering (Mc Donald)
DO NOT USE THIS FORM FOR:
Name Changes such as:
• Legal name changes
• Addition of a middle name
• Change your surname (e.g. maiden name to married name)
• Nicknames or name variations (e.g. Charles to Charlie)
You
may request for these types of changes by submitting a name change form to the Registrar’s Office.
At the time of your request, you will be asked to provide supporting documentation. For more
information, go to: http://www.cpp.edu/~registrar/academic-policies/name-change.shtml
.
Name: BroncoNumber:
Quarter/Year Applied to Graduate: Degree: □ Undergraduate □ Graduate
Email: @cpp.edu Contact Phone Number:
Indi
cate below how you request your name to be printed on your diploma.
INSTRUCTIONS:
1. Legibly enter one letter or blank (space) per box.
2. Draw distinct special characters with their corresponding letter.
3. Clearly indicate upper/lower case lettering.
*Every effort will be made to accommodate your request, however, some characters may not be
available for printing and you will be notified.
Signature: Date:
OFFICE USE ONLY
Processed: Date By
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DIPLOMA NAME REQUEST FORM This form is to (California Polytechnic State University, Pomona)

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Completed 28 January 2021

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