DOCTORAL RENTAL ORDER FORM
University of Pennsylvania
Academic Regalia Order Form
PLEASE PRINT CLEARLY
Last Name:
E-Mail:
Height (in feet):
First Name:
Phone:
Weight (in pounds):
DEGREE TO BE CONFERRED
School of Nursing
School of Dental Medicine
o
Doctor of Dental Medicine (Lilac)
o
*Includes: Keeper Tam and Tassel, Rental Doctor Gown and Rental Doctor Hood
o
School of Veterinary Medicine
Doctor of Science in Dentistry (Science Gold)
*Includes: Keeper Tam and Tassel, Rental Doctor Gown and Rental Doctor Hood
o
School of Law
o
o
*Includes: Rental Mortar Board Cap and Tassel, Rental Master Gown, and Rental JD Hood
Juris Doctor / Doctor of the Science of Law (Purple)
*Includes: Keeper Tam and Tassel, Rental Doctor Gown and Rental JD Hood
Doctor of Veterinary Medicine (Grey)
Perelman School of Medicine
Master of Laws / Master of Law / Masters of Comparative Laws (Purple)
o
Doctor Medicine (Hunter Green)
School of Social Policy & Practice
Graduate School of Education (GSE)
o
Doctor of Nursing (Apricot)
Doctor of Education (Light Blue)
o
Doctor of Social Work (Citron)
o
ALL PHD’S (PHD Blue)
RENTAL PAYMENT INFORMATION
Juris Doctor and Doctor of Science in Law Regalia: $124.00 plus tax ($9.92) = $133.92
Doctor of Dental Medicine and Doctor of Science in Dentistry Regalia: $124.00 plus tax ($9.92) = $133.92
All other Regalia: $74.00 plus tax ($5.92) = $79.92
ONLY IF HAVING ORDER SHIPPED
SHIPPING ADDRESS:
Shipping fee (circle one): Flat Rate Ground 7.50
/
2nd day 11.95
/
Next Day 16.95
CC # _____________________ Exp. Date: ____ / ___ Security Code: ______Billing Zipcode:_______
Signature:
_______________________________________
No Refunds or Exchanges after May 1st (receipt required)
If form not submitted in store, please e-mail or fax to
Jillian Nichols / email: [email protected] / fax: 215-898-6997