Authorization to Pick Up Official Documents
Office of the Registrar / 200 West Kawili St. Hilo, HI 96720-4091 / Student Services Center, First Floor Rm 101 / Phone: (808) 932-7447 / Fax: (808) 932-7448 / E-mail:
You may designate a third party to pick up your certification or diploma at the Office of the Registrar, as long as our office receives a signed copy of this
form prior to pick up.
Authorized third party must present a valid photo ID at time of pick up and sign after documents are received.
SECTION I: Student Information
Name: ________________________________________________________________ Student ID: _______________________________
Last First MI
Email: Phone: __________________________________
SECTION II: Authorization for Third Party
Authorized person: _____________________________________________________
(Print third party name)
Pick up document: Certification Diploma Other: ___________________________________________
Student Signature: ______________________________________________________________ Date: ____________________________________
Third Party Signature: ____________________________________________________________ Date: ____________________________________
FOR OFFICE OF THE REGISTRAR USE ONLY: Verified By: _______________ Date: _______________ Revised 08/2017
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