Diploma Pick-Up Authorization Form

Students who would like to authorize someone else to pick up their diploma must complete this form ahead of time.

Diplomas will not be released to anyone other than the student unless this form is on file.
The person picking up the diploma must provide photo identification.

Your diploma will not be released if you have a hold on your account. Please check hold status in Self-Service Banner before submitting this form.

Student Name Student Name First Last
Student ID
Student Cell Phone Number
Student Email
Name of Person Picking Up Diploma
Cell Phone Number of Person Picking Up Diploma
Email of Person Picking Up Diploma

Please be sure this email address is accurate. The person picking up the diploma will need to show this form at the time of pickup along with their identification.
By entering your name below you authorize the University of New Haven to release your diploma to the person listed above.

I understand that this is the one copy of the diploma that is provided by the University, and that it is my responsibility to pay for any additional copies.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY