OfficeoftheRegistrar
Diploma/CoverReplacementForm
Pleasecompletethisformifyouneedtoreplaceyourdiplomaandcover.Thediplomamustbeorderedusing
thenamewithwhich
yougraduated.SVSUcanonlyduplicatediplomasforWinter1988semestergraduates
andon, otherwise a special order will need to be placed.
Thecostofthediplomasis$13.00,andthecostofanadditionalredcoveris$19.00.Paymentmustbemade
priortoprocessingandcanbecompletedeitherattheCampusFinancialServicesCenter(creditcard
paymentscanbemadebycallingtheirofficeat(989)964‐4900)orbymailingacheck(madepayableto
SaginawValleyStateUniversity)withthisform.
PleasemailthisformtotheOfficeoftheRegistrar(attheaddressbelow)orfaxitto(989)964‐2555.
SaginawValleyStateUniversity
OfficeoftheRegistrar
7400BayRoad
UniversityCenter,MI48710
Pleaseallowforseveralweeksfordiplomaprocessing.
Completethefollowinginformation:
___________________________________________________________________________________________
Nametoappearonthediploma(useupper&lowercaseletter)
______________________________________ __________________________ __________________
Degree GraduationDate Honors
______________________________________ __________________________ __________________
Signature SocialSecurity StudentIDNumber
CoverOnly($19.00)
DiplomawithCover($32.00)
Checkone: DiplomaOnly($13.00)
Addresstobemailed:
___________________________________________________________________________________________
StreetAddress
___________________________________________ _________________________ ____________
City State Zip
(______)____________________________________ __________________________________________
TelephoneNumber EmailAddress
AmountPaid:________________ ReceiptNumber:___________________ DateMailed:_______________
click to sign
signature
click to edit