Diploma Pick-Up Authorization Form 


Please print and complete this form if you would like to authorize another person to pick up your diploma. 



Student Information – Please print clearly 


EMPLID (CUNYfirst ID) ___________________________________


Last 4 Digits of SSN  ___________________________________           Date of Birth ________________________

 

Last Name _________________________________


First Name ________________________________


MI __________________


Name while attending (if different) _________________________________

 

Street Address ___________________________________________          City, State, Zip ______________________

 
Phone ____________________________________


Email ____________________________________



Please provide the following to complete your request: 

. Copy of student’s valid Identification card (Lehman College ID or Government-issued ID) 
. Proxy’s valid Identification card (Government-issued ID) 


I hereby authorize (print) ____________________________________________________to pick-up my 
diploma, certificate, or advanced certificate on my behalf. 



Conferral (Graduation) Date _________________________________________


Academic Program (Degree)   _________________________________________


Academic Plan (Major)       _________________________________________

 


Authorization: 


I authorize Lehman College, CUNY to allow my proxy named above to pick-up my diploma, certificate, or 
advanced certificate on my behalf. 


Student Signature ________________________________________                     Date __________________

 
Proxy Signature   ________________________________________                     Date ___________________ 

 
If you have any additional questions or concerns regarding the information above, kindly refer all inquiries to 
Graduation.Audit@Lehman.cuny.edu (or) call the Graduation Audit Office (718) 960-7474. 



Office Use Only 

Received by: ______ Date: _______ 
Processed by: ______ Date: _______