Fillable REPLACEMENT DIPLOMA REQUEST FORM (Simmons College)

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REPLACEMENT DIPLOMA REQUEST FORM (Simmons College)

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SIMMONS UNIVERSITY
Office of the Registrar
300 The Fenway, Boston, MA 02115
Tel 617.521.2111 Fax 617.521.3144
REPLACEMENT DIPLOMA REQUEST FORM
Current Name: ____________________________________________________________________
Name During Attendance: __________________________________________________________
Simmons ID # or last 4 digits of SSN: ____________________________________
Date of Degree Conferral: ___________________________________________________
Degree Received: _______________________________________________________
Date of Birth: _____/______/______ Daytime Phone: _______________________________
E-mail Address: ____________________________________________________________________
Checks and money orders should be made payable to Simmons University.
*If you need proof of graduation, you may request a degree verification. Verifications are free of charge
and are processed in 1 business day. To request a verification please see the verification request form. *
*All Diplomas produced after 9/1/2018 will say Simmons University, regardless of when you attended.*
Provide mailing address for diploma:
Name
Street
City, State, Zip
Signature: ______________________________________ Date: ___________________
OFFICE USE ONLY: Amount Paid ____ Check ____ Cash ____ Date ____ Initials ____
TYPE OF REQUEST
FEE
PROCESSING TIME
# OF COPIES
REPLACEMENT
DIPLOMA
(DOMESTIC)
$50 per copy
Estimated 4-6 weeks to receive replacement
diploma from vendor once we have received
request and payment.
REPLACEMENT
DIPLOMA
(INTERNATIONAL)
$75 per copy
Estimated 4-6 weeks to receive replacement
diploma from vendor once we have received
request and payment.
RUSH
REPLACEMENT
DIPLOMA
(DOMESTIC)
$100 per copy
Estimated 3-4 business days to receive
replacement diploma from vendor once we
have received request and payment.
RUSH
REPLACEMENT
DIPLOMA
(INTERNATIONAL)
$150 per copy
Estimated 3-4 business days to receive
replacement diploma from vendor once we
have received request and payment.
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REPLACEMENT DIPLOMA REQUEST FORM (Simmons College)

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Completed 24 July 2020

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