Replacement Diploma Request Form
Please note: Financial obligations to Fontbonne University must be satisfied in order to release diplomas. Request
must be in writing, completely filled out, and signed by the graduate.
This request form can be:
Mailed to: Fontbonne University – Registrar’s Office – 6800 Wydown Blvd. – St. Louis, MO 63105
Faxed to: Registrar’s Office at 314-889-1487
Emailed to: registraroffice@fontbonne.edu
__________________________________________________________________________________________
Name Student ID # or Last 4 SSN
__________________________________________________________________________________________
Phone Number Other Name while attending Fontbonne University
__________________________________________________________________________________________
Street Address City State Zip Code
___________________________________________________________ ______________________________
Student Signature (physical signature required) Date
□ Request Replacement Diploma
$25 fee for each Replacement Diploma, includes mailing in the United States, International mailing fees will vary
Number of Replacement Diplomas: __________________ Total Fee: $____________________
OR
MAIL TO:
__________________________________________________________________________________________
Name/Department/Institution
__________________________________________________________________________________________
Street Address City State Zip Code
Credit card information:
□Visa □MasterCard □Discover
Number________________________________________ Expiration Date_________________ CVV Code_________
□ Paid with check number ___________________ □ Paid with cash
click to sign
signature
click to edit
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