Fillable Replacement Diploma Order Form Y (University of Wisconsin)

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Replacement Diploma Order Form Y (University of Wisconsin)

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Country of origin: US
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Replacement
Diploma Order Form
The cost is $35 per replacement diploma, payable only with a check or money order.
Please allow 4 - 6 weeks for delivery.
Y
our name as it appears on your UW Colleges student records:
middle name last name
Campus ID number (if you know it):
7 digit number
Date of Birth :
month
day year
Email address:
Telephone:
Your degree:
type date awarded (mo/yr)
campus where degree was earned
Mailing address:
number and street, city, state, postal code, and country (if not USA)
Your signature:
sign or type your name
date
Please include your check or money order, payable to University of Wisconsin Extended Campus.
Office of the Registrar
5602 Research Park Blvd., Ste 300
Madison, WI 53719
phone: 877-UW-LEARN
fax: 608-265-9396
oel-registrar@uwex.edu
wisconsin.edu/uwc
SUBMIT TO
Diploma name:
fi
rst name
name as it should appear on diploma
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Replacement Diploma Order Form Y (University of Wisconsin)

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Completed 27 July 2020

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