School of Medicine

Name:              

Department:      

Telephone #:     

I have my own academic regalia
Please order academic regalia for me

Male   Female

Jacket or Dress Size:   

Height:   

Cap Size:       or inches   
(If cap size is not known, please measure head circumference with a tape measure and include that information)

The information listed below must be complete or the appropriate "hood" from your conferring institution cannot be ordered and a WSU hood will be substituted.

Degree:  
D.O.   
M.D.   
Ph.D.   
Other  

Degree Granted from:          School:

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