Fillable DIPLOMA REPLACEMENT REQUEST (Walla Walla University)

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DIPLOMA REPLACEMENT REQUEST (Walla Walla University)

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DIPLOMA REPLACEMENT REQUEST
Walla Walla University Academic Records Office
204 S. College Ave., College Place, WA 99324-3000
TEL 509-527-2811 FAX 509-527-2574
Date: _________________________
The minimum office preparation time required will be 2 weeks. Please include payment as requested.
Please print YOUR NAME and MAILING ADDRESS below.
________________________________________________________
First Middle Last
______________________________________________________________
______________________________________________________________
WWU ID Number: _______________ Date of Birth: ________________
Social Security Number: ________________ Tel: __________________
Degree Information: _____________________________________________
Year Quarter Degree
_____________________________________________
Year Quarter Degree
( ) Diploma to be mailed (within the next 2 weeks)
( ) Diploma to be picked up on: _____________________________
Date
( ) Send diploma by FAX to: _______________________________
Fax number
Fax to attention of: ____________________________________
Special Instructions: _______________________________________
Please carefully print below the address to which your diploma(s) will be mailed:
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Please complete payment information below.
To assist in retrieving your records, please list
ALL your previous names.
__________________________________________________________
_____________________________________
Enter your name below exactly as you wish
it printed on your diploma.
_____________________________________
NOTE: ALL DIPLOMAS NEED RELEASE
APPROVAL FROM STUDENT FINANCIAL
SERVICES. DIPLOMAS WILL NOT BE
RELEASED UNTIL ACCOUNT and/or WWU
CO-SIGNED BANK NOTE IS PAID IN FULL.
_____________________________________
Student Signature
(Required on ALL requests)
For office use only
Financial Clearance __________________
Date diploma mailed _________________
Date diploma picked up ______________
Date diploma faxed __________________
Amount paid _______________________
…
…………………………………………………………………………………………………………………………………………………………………………………
PAYMENT INFORMATION
Replacement, shipping & processing fees:
Undergrad Graduate
Diploma $20 $25
Diploma cover $15
$20
Mini diploma $
5 $ 5
Diploma/cover/mini $35
$45
Payment method:
Cash Visa
Check Master Card
Credit Card Discover
Credit card information:
Name on Card: ____________________________
Card #: __________________________________
Expiration Date: ___________________________
Security Code (on reverse side of card): _________
Signature of Card Holder
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DIPLOMA REPLACEMENT REQUEST (Walla Walla University)

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Completed 2 February 2021

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