DRS ALUMNI DIPLOMA REQUEST

STUDENT LEGAL FIRST NAME *

STUDENT FIRST NAME AS KNOWN IN DRS *

LAST NAME *

YEAR GRADUATED *

EMAIL *

CONFIRM EMAIL *

CELL PHONE *

ALL DIPLOMAS WILL BE SENT ELECTRONICALLY.

NAME OF PERSON OR INSTITUTION REQUESTING DIPLOMA *

EMAIL ADDRESS FOR PERSON OR INSTITUTION REQUESTING DIPLOMA *

FEE *

DIPLOMA REQUEST FEE ($10.00)

ADDITIONAL COMMENTS OR QUESTIONS

Please note: All requests take three to five days to process

and must be cleared by the educational and business offices

For questions please contact Sue Weinberg at sweinberg@drshalb.org.