In Absentia Form

Complete, Mail or fax request form to: Office of the Registrar ATTN:  In Absentia Statement 311 North 5th Street Camden, NJ 08102-1405 Fax:  (856) 225-6453

This form confirms that I will not be attending the Camden Campus Commencement Ceremony in May
and would like my diploma mailed to the address listed below.

Note:    All information must be completed in order to fulfill your request.

Full Name (last, first, maiden): _____________________________________________________________

Student  I.D. Number (SSN): _______________________________________________________________

Student Email Address: __________________________________________________________________

Student  Telephone: _____________________________________________________________________
 

Graduation date: (Check)

____October

____ January

____May

Year 20_______________

Check School of Attendance:

____Camden College of Arts & Sci (50)	____Univeristy College (64)	____ School of Business-Undergrad (52)
____ School of Business-Graduate (53)	____ Graduate School-Camden(56)	____ School of Law-Camden (24)

Diploma Mailing Address: ________________________________________________________________

                                                ________________________________________________________________
 

Please call the above telephone number.  I prefer to pick up the Diploma when ready. I understand I must have  appropriate identification before the diploma is released to me.

"X" Box for pick up

Degree(s)  received: ______________________________________________________________________

Student's  Signature: ________________________________________________  Date: ________________