DeVry Long Island City Graduation Application

Graduation Application

For February 2010 Graduation
If you would like to authorize someone else to pick up your diploma on your behalf, please make sure you put this request in writing with your DSI, the name of the individual, and your signature. Make sure this request is given directly to Juline Robinson in Room 236.

Student Information

* Major:	* DSI:	* Location:

Name as you would like it to appear on your diploma:
* First Name:	Middle Name:	* Last Name:

My diploma should be mailed to:
* Address		* City

* State		* Zip Code

* Phone Number ( e.g.(xxx)xxx-xxxx - no spaces )	* Email Address

Submitting your application serves as consent to the use of your name in the Commencement program and to being photographed during the event. I also understand that such photographs may be used by DeVry College of New York in marketing and promotional materials.