CONGREGATION FOR THE CONFERMENT OF

DEGREES AND OTHER AWARDS

School of Engineering and Physical Sciences
(Chemical / Electrical / Mechanical Engineering)
Thursday 23 June 2011
10 am

Personal Details

Full Name:

ID Number:

Title of Award:

Email Address:

Contact Number:

Contact Address:

In Absentia Address:
(Certificates will be sent to
this address)

Please confirm below how you intend to graduate and receive your award (tick one box only)

I intend to graduate in person to receive my award on Thursday 23 June 2011

I intend to graduate in absentia on Thursday 23 June 2011

(Certificates will be sent recorded delivery and will require a signature – please allow 4-6 weeks from the
graduation date for delivery)

I intend to delay my graduation to receive my award in person in November 2011

Guest Tickets

Complimentary guest tickets for the ceremony (Maximum 2)

Number additional guest tickets for the ceremony (£15.00)

Graduation Fee and Declaration

I hereby make an application to graduate and enclose the mandatory graduation fee of £45.00. I understand that
my name will be published in the list of graduates and that my former place of study will be informed of my
graduation and degree title (unless otherwise requested in writing) and that a DVD recording will be made of the
ceremony.

Signature: Date:

Please do not pass my details to the Alumni Department at Heriot-Watt University  (tick)
(This information is used to keep in touch with you via Magazines, E-Newsletters and Event Invites after graduation)

Form(s) should be returned to the Student Service Centre by 2 May 2011. If your form is not received by this date,
there is no guarantee that you will be able to graduate. Please see the Academic Registry website for further
details http://www.hw.ac.uk/registry/graduation.htm

Office use only: JUN-ED-6

Certificate
GF 2403 0117 C11 GR 2403 0527 C11
Programme Sent /Collected
Grad Fee Paid £ Tickets Paid £
Number Date
Date Date
Student Service Centre, Hugh Nisbet Building, Heriot-Watt University, Edinburgh, United Kingdom, EH14 4AS
CONGREGATION FOR THE CONFERMENT OF
DEGREES AND OTHER AWARDS
School of Engineering and Physical Sciences
(Chemical / Electrical / Mechanical Engineering)
Thursday 23 June 2011
10 am

Method of Payment

Please Note:

• The graduation fee is mandatory; those wishing to graduate in absentia are still liable for the
graduation fee.
• A charge of 1.75% will be added to the payment for use of a credit card, to cover the cost of
processing to the University
• Cheques/Bank Drafts should be made payable to Heriot-Watt University in Pounds Sterling and
Crossed.

Graduation Fee £45.00

Complimentary Guest Tickets (maximum 2) £free

(Guaranteed to be seated in the Main Auditorium)

Number of Additional Guest Tickets (£15.00 each) £_____

(If the ceremony is oversubscribed, any additional guests may need to
be seated in an allocated seating area with a video link to the Main Auditorium)

Total Cost for Graduation £_____

Credit/Debit card payments – please fill in the details below clearly

………………………………………………………………………………………………………………………
This portion of your form will be destroyed after payment has been taken
Please note; we cannot process your payment unless all details are completed

Please tick or complete the appropriate boxes below

Credit Card Type Debit Card Type

MasterCard  Visa  Switch/Maestro  Switch Issue No.  Visa Debit/Delta 

*We are unable to take payment remotely from a Visa Electron Card

Card Details

Valid From Date: Expiry Date: Security Code:

(Last 3 digits on signature strip)

Long Card Number:

Name of Cardholder:

Signature: Date:

Student Service Centre, Hugh Nisbet Building, Heriot-Watt University, Edinburgh, United Kingdom, EH14 4AS