Not to be Filled School Name:in by School City/State:

FS # Information furnished by:__________ Title:

CM # __________ If you are a new customer to Jostens:DT & Int. Type title and name of the official on name & title lines.

__________ Include actual signature of official within the guides below the name & title lines. For appropriate sizing, Ref # please fill in the space using the gray lines as guides. Anything in the black region will not display on the

__________ diploma, please stay within the black guides. Repeat for all officials.

If you are a current Jostens customer: (signatures from last year are on file - we still need to verify all names and titles for this year.Actual signatures and titles are on file (do not resubmit signatures that have been previously submitted). Type title and name of theofficial using the name and title to print lines below (we will use for verification purposes). To add or change a name or title – Type titleand name using name and title to print lines. Mark appropriate box. Include actual signature of official within the guides below the name & title to print lines. For appropriate sizing, please fill in space staying within the black guides. Repeat for all officials that are new.

Signatures appearing on your diplomas are photo reproductions of signatures below. Use FINELINE black felt tip pen,signing within the guides. Do not use wide tip pens or ballpoint ink, they do not produce well.Please make sure when folding that there are no creases on the actual signatures.

Name (typed) Name (typed)Title to print Title to printAs Last Year New Official Position Change As Last Year New Official Position ChangeNO Change Name Change Signature Change NO Change Name Change Signature Change

Name (typed) Name (typed)Title to print Title to printAs Last Year New Official Position Change As Last Year New Official Position ChangeNO Change Name Change Signature Change NO Change Name Change Signature Change

Name (typed) Name (typed)Title to print Title to printNO Change New Official Position Change As Last Year New Official Position Change

Name Change Signature Change NO Change Name Change Signature Change

Phone: 800-413-3857 Ext: Mail to: HS Diploma 148 E Broadway Owatonna MN 55060

or scan & e-mail to: hsdiplomaservice@jostens.com

Instructions for Submitting Diploma Signatures