Student Cap & Gown Order Form (please complete form electronically)
Student Information
Male
Student Name:
Phone:
Female
Cell:
Email:
S TUDENT/S CHOOL I NFORMATION
Souvenir Gowns – DO NOT NEED TO BE RETURNED
Included in Graduation Fee on SHP Student Tuition and Fees
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School of Health Professions
*Deadline(s): Summer/August: June 19, 2015 for Commencement Date: Friday, August 14, 2015
* $15 late fee after order deadline.
Measurements:
Chest:
Height
Weight
Please select program of study:
Bachelor of Science in Clinical Laboratory Sciences
Bachelor of Science in Respiratory Care
Master of Science in Nutrition and Metabolism
Master of Occupational Therapy
Master of Physician Assistant Studies
Master of Science in Clinical Laboratory Sciences
Master of Science in Health Professions
Master of Science in Transfusion Medicine
Doctorate of Physical Therapy
TAM CAP SIZE (DPT ONLY)
The Bookstore has sample tams to determine sizing.
DPT Tams @ $42.99 plus 8.25% sales tax TOTAL $46.54
Please remit payments with this order form to: UTMB Health - Bookstore
(Check one)
Card Number
Signature
Cash
Check or Charge
SEC Code
AmEx
Visa
MC
Discover
Expiration Date
Card Holder Name
PICK UP FOR CAP & GOWNS WILL BE THE WEEK OF GRADUATION.
An email will be sent with more details. If you are unable to pick up your regalia
from the bookstore in advance, you can pick up at Moody Gardens after rehearsal.
UTMB Bookstore
914 Market St
Moody Medical Library, Room 1.106  Galveston, Texas 77555-0936
(409) 772-1939 Phone  (409) 772-3440 Fax UTMB.bookstore@utmb.edu E-mail