IDENTIFICATION (Student ID # or last 4 digits of SSN required): ____________________________________
NAME: _________________________________________________________________________
Name you used while at HPC/ HLC/ HPU if different from name above:
Name to appear on diploma (upper and lower case, if name is different than name originally on file with HPU, identification documentation will be required) :
Degree: ________________________________________________________
Concentration/ Major: ______________________________________________
Month & Year Completed:___________________________________________
Honors Shown on Diploma: _________________________________________
Mailing Address (Please print legibly):
Name: _____________________________________________________
Street: _____________________________________________________
City/State/Zip Code: __________________________________________
Country: ____________________________________________________
________
Date:
Please enclose with this order form: U.S. Check/ Money Order payable to Hawaii Pacific University or
Credit Card: VISA______ MasterCard ______
_________/________
Diploma orders will be processed on the 15th of each month as long as the overall minimum order of 10 diplomas has been met. If the minimum
order has not been met, the order will be postponed until the following month unless expedited printing has been selected.
Please allow approximately 4-6 weeks for processing and delivery unless expedited printing and/or shipping is selected.
OFFICE USE ONLY
DATE: _________________________
RECEIPT: ______________________
Exp. Date
Last Name
First
Middle
REQUEST FOR AN ADDITIONAL DIPLOMA
3 Digit Card Code
Credit Card Numer
HAWAI‘I PACIFIC UNIVERSITY
500 ALA MOANA BLVD, SUITE 5A
HONOLULU, HAWAI‘I 96813
PHONE: (808) 544-0239
EMAIL: ptg@hpu.edu
REV. 07/19
Phone #: _____________________________________ Email:
STUDENT'S SIGNATURE: ______________________________________
(Digital signatures not accepted)
DIPLOMA PROCESSING FEE: $25
Expedited Diploma Printing: +additional $25
Reques
t for Diploma Cover: +$10
E
xpedited Shipping: +$_______
(Contact HPU for current shipping charge)
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