AUTHORIZATION LETTER FOR DIPLOMA PICK-UP 

 

 

Date ____ / ____ / ____ 

 

To: The Office of the Registrar: 

Graduation Audit 

Shuster Hall, Room 102 

250 Bedford Park Blvd West 

Bronx, New York, 10468 

 

 

I, ___________________________________ authorize _______________________________________ 

(Your name here) (Person authorized to pick-up diploma on my behalf) 

Please print clearly Please print clearly 

 

 

to pick-up the diploma on my behalf. The details are as follows: 

 

EMPLID OR Last (4) of SSN #: ______________________________________________ 

 

 

Degree Earned: _______________________________________________ 

 

Graduation Date: ______________________________________________ 



 

For Notary Public Use Only 

 

 

 

 

Sincerely, 

 

 

______________________________________________________ 

Signature of Graduate (original signature mandatory) 

 

 

 

This document must be notarized by the student. 

A copy of the student’s valid government issued ID MUST be accompanied with this form. 

The person designated to pick-up your diploma MUST also present a valid government issued ID. 

 

*Please note that faxed and otherwise electronically sent copies will not be accepted. The original signed form MUST 
accompany the person designated to pick-up your diploma.