APPLICATION FORM FOR APOSTILLE 

1.     NAME________________________________________DATE:______

2.     COUNTRY THAT REQUIRES APOSTILLE__________________________

3.     SCHOOL, DEGREE, YEAR AND DATE ON ORIGINAL  DIPLOMA _______________________________________________________

_______________________________________________________

4.    REASON FOR REQUEST

        _______________________________________________________

5.     STUDENT ID Number_____________________

         OR Date of Birth_________________________

6. MAILING ADDRESS&TELE NO.______________________________

_______________________________________________________

_______________________________________________________

7. ****IF YOU WANT YOUR DIPLOMA SENT DIRECTLY FROM THE STATE TO YOU, PLEASE GIVE US A CREDIT CARD NUMBER FOR FED-EX CHARGES.

   _____________________________________________________

Card Number

  ______________________________________________________

Expiration Date

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

There is a  $15.00 fee for processing the Apostille.   The check should be made out to the Trustees of the University of Pennsylvania.

The State charges $15.00 per document to be sealed.  The check should be made out to the “Commonwealth of Pennsylvania”.