REQUEST FOR DUPLICATE DIPLOMA
NAME ______________________________________________________________________________ STUDENT ID NO ________________________________
Last First
CURRENT MAILING ADDRESS _________________________________________________________________________________________________________
Street/Apt. No.
_____________________________________________________________________________________________________________________________________
City State ZIP Code
LOCAL PHONE _______________________________ HOME PHONE ___________________________ WORK PHONE ______________________________
STUDENT SIGNATURE ________________________________________________________________ DATE ________________________________________
DEGREE RECEIVED ______________________________________________________________ GRADUATION DATE _______________________________
(i.e., Master of Science in Computer Science)
o Name Change
o Destroyed Diploma
o Damaged Diploma
o Lost/Stolen Diploma
o Other ________________________________________________________________________________________________
RGR-492-0220
The fee for a duplicate diploma is $50, payable by check or money order made out
to Florida Tech. To pay by credit card, contact graduation @t.edu.
Florida Tech’s policy allows issuance of one duplicate diploma.
If you have a name change, submit a certied copy of an original marriage license,
court decree, or passport, along with an address/name change form available
online and from the Registration Center. Since the name on your diploma must be
the same as the name in Florida Tech’s database, your name will also be changed in
our database.
Please allow three weeks for processing
STUDENT INFORMATION
DEGREE INFORMATION
REASON FOR REQUEST
Florida Institute of Technology Oce of the Registrar 150 West University Boulevard, Melbourne, FL 32901-6975 321-674-8115 Fax 321-674-7827
