Diplomas will be delivered to your address below. Please allow 4-6 weeks to receive diploma.
Name as it appears on diploma:
Last Middle First
Previous name (if any):
Last Middle First
Address:
Street Apt. # City State ZIP Code
Student ID
or SSN#:
Date of Birth:
Month
/
Day
/
Year
Degree earned:
* Associate of Science * Associate of Applied Science
* Associate of Arts * Certicate
Major:
Graduation
Term:
Semester
/
Year
Phone:
Email:
Signature: Date:
FOR OFFICE USE ONLY:
Diploma Mailed On: _________________________________________________________________
Notes: _____________________________________________________________________________
___________________________________________________________________________________
DIPLOMA REQUEST
FORM
OFFICE OF ADMISSIONS AND RECORDS • P.O. Box 2216 • Decatur, AL 35609
Graduates requesting a replacement of a previously issued diploma and
graduates who did not originally request a diploma upon completing the
graduation application should submit this form.
(Rev. 11/19)
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