Diploma Reorder Form
Office of the Registrar
3900 University Blvd., STE 230
Tyler, Texas 75799
Email: graduation@uttyler.edu
Please return this form to the Office of the Registrar (STE 230) with receipt of fee paid.
Note: Normal delivery period is 6-8 weeks after the order is placed.
Student Record Name: _________________________________________________________________________
(Print your name as it appears on your student record file.)
Student ID Number: ____________________________ Today’s
Date: __________________________
(Ten digits, beginning with 5000/6000)
Phone Number: (_________) __________ - _________________________
Email: _________________________________________________________________________
Diploma Name: _______________________________________________________________________________
(Print your name exactly as you wish it to appear on your diploma.)
Hold for Pick Up:
Diploma Address: ________________________________________________________________________
(List physical address where diploma is to be mailed)
________________________________________________________________________
(City/State/Zip)
Degree to be ordered (check one): Bachelor Master Doctoral
Graduation Term and Year: _______________________ Latin Honors: ________________________
(Ex. Fall 2007) (Ex. Cum Laude)
Major Field(s) of Study: __________________________ Quantity Requested: ____________
(Ex. Nursing, History, Management, etc.) (Each diploma requires a separate $25 fee)
Additional Notes: __________________________________________________________________________
__________________________________________________________________________
For Office Use
Conferral Date: _______________________ Fee Paid: Yes Waived
Damaged: Yes No Diploma Returned Date: ___________________
Reprinted Mailed Date: _______________________