Request to Mail Diploma or Cercate
Student ID Name:
Other Name(s) under which you aended
Dates of aendance: From / to /
Major/Degree Plan at me of graduaon:
Address to which the diploma should be mailed: (Post Oce Boxes are not acceptable)
To the Aenon of
Address Line 1
Address Line 2
City State Zip Code
Contact Phone Email
PLEASE NOTE: Your diploma will be mailed using USPS Cered Mail services. Someone must sign for the package when it arrives. Keep this in mind
when lisng the address to which the diploma should be mailed. Addional fees will be assessed to diplomas returned to our oce.
If this request contains an INTERNATIONAL ADDRESS please check here and write the complete address EXACTLY AS IT SHOULD APPEAR on the back
of this form. There is an addional $75 fee for internaonal addresses. LC is not responsible for diplomas that do not arrive.
By my signature I aest that I live more than 50 miles away, and am eligible to request my diploma be mailed to me.
Signature Date
Fee Payment Due:
Fee for not aending
commencement ($100)
(Assessed to Graduate-
Level Students ONLY)
Internaonal address fee
($75)
Addional Diploma ($36)
Other: ______
Receipt of payment must be
aached.
This area for Oce Use Only
