LOGO_3 Diploma Mailing Request Please use this form to request that your diploma be mailed to the address you have on file. Student Information – Please print clearly EMPLID: D.O.B. / / Last 4 Digits of SSN (in attendance prior to SPRING 2012 semester) Last Name First Name Middle Initial Street Address: City, State, Zip: Phone (_____) _____ ---- _________ Email: Please provide the following to complete your request - . Priority mailer form the U.S. Post Office (Unused) . Self-addressed with prepaid postage . Priority Mailer Padded Flat Rate Envelope 9 ˝ x 12 ˝ (Mailer MUST be size noted above and padded due to diploma case) . Identification card (State-issued identification card) Conferral Date: Academic Program (Degree): Academic Plan (Major): College Honors (if applicable): Student Signature Date PROXY PICK-UP If you prefer to have your diploma picked up by a friend or relative (PROXY), please follow the instructions found at the following link http://lehman.edu/registrar/graduation-information.php to download & complete your PROXY request. If you have any additional questions or concerns regarding the information above please refer all inquiries to Graduation.Audit@Lehman.cuny.edu (or) call the Graduation Audit Office (718) 960-7474. *Please note that the Registrar’s Office is not responsible for diplomas that are lost in transit Office Use Only: Thank you, Received by: _________ Date: _____ Office of the Registrar Processed by: ________ Date: ______