Fill in the appropriate fields, print the form, and submit the form to the apposite office listed at the
bottom of the page. Students with dual-degree programs, must file a separate application for each degree.

Student Identification: 

PRINT YOUR NAME as it should appear on your diploma (include accent marks and punctuation.)

  Last          First         

Middle         Suffix 

 Please check here if the above name (or middle initial) is different from your name on your Rutgers
     University permanent record card. If so, you must submit a "Name Change Form" to the Office of The 
     Registrar, or the name on your permanent record will appear on your diploma. Your permanent record
     name must be the same. To download a Name Change Form, CLICK HERE. 

Mailing Address: Street    City   

                  State   Zip Code                      

Phone Numbers: Home    Work    Cell           

I plan to graduate in  January  May  October  of  

Preferred Email Address        

College/School  Arts & Sciences  School of Business  University College

                School of Law  Graduate School 

Degree BA BS MA MS MBA MPA MALS JD MPT BHM PHD Other_____


Please add your major(s) and minors(s) including the appropriate curriculum codes.
Major   Major Code   Major   Major Code 

Minor   Minor Code   Minor   Minor Code 

STATEMENT OF ABSENTIA:  I SHALL NOT ATTEND commencement. Send my diploma to the address above,
                           after the ceremony.

DISCLAIMER STATEMENT:  I understand that completion of a Diploma Application does not imply graduation
                          requirements  have been satisfied. I understand and accept the disclaimer statement.


Signature: _________________________                                                       Date: __________


Submit this form to: 
                     Law                MBA                  Undergraduate           Graduate
                     Maureen Aguilar    Joany McCracken      Student Affairs         Julie Strasser-Deans Office
                     600L Law School    247 Bus.&Sci. Bldg   2nd Fl. Armitage Hall   3rd Fl. Armitage Hall
                Fax: (856) 969-7938     (856) 225-6231       (856) 225-6049          (856) 225-6737