_____________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Request for Replacem e n t or Duplic a te Diploma or Certificate
Webster University
Office of the Registrar
47 E. Lockwood Ave.
St. Louis, M o 63119
Current Information: Date: ______/______/______
Name: ___________________________________! Student ID /L a st 4 of!Social Se cu rity No.: _____ __ __ ________
Former N ame!(if applicable): ____________________________________!Date of Birth: ______/______/_______
Current Address: ______________________________________________________________________________
City: ______________________________ State: _____! Zip Code: ____________ Country: _______________
Home Phone: (____) ____V______! Cell Phone: (____) ____V ______! Email: _____________________________
SIGNATURE:'_____________________________'
The Fee for!a reVprinted!diploma or certificate is $25.00 per document. If you rece ived any honors certificate(s)
and want a reprint please!check the!appropriate!box(s) below. The reprinted!diploma or certificate that you!will
receive may or!m a y not be an!exact replica of the original that you!received, depending upon when!you!graduated.!
The style of the diploma!and certificates have changed and all reprints are!done!using the curren t!form at! inc lu d in g
the signatures of!the current!administration . Please!download and complete!the!form. Mail the!completed form
along!with a check or money order made!payable!to Webster University to the above address.
Diploma inform ation Please!print your name exactly as you!want it to appear on the!diploma.
First Middle Last
Degree Received: _______________________________ Major: _________________________________
Emphasis: ______________________________
Requested'Diploma s :
Diploma No.!of copies requested ____!
Diploma with!Apostille (Additional $100.00
per diploma)! No. of copies!requested ____
Requested Certificates:
Undergraduate Level:
Departmental Honors No.!of copies requested!____
Undergraduate Academic Honors (Latin Honors) No. of copies requested ____
Graduate Level:
Graduate Academic Honors No.!of copies re qu e ste d ____
Amount Due $___________ Method of Payment: (Please!check one) Check Money Order
Address where diploma is to be mailed!(If different from above)
Name: ___________________________________!
Ad
dress: ______________________________________________________________________________
City: ______________________________ S
tate: _____! Zip Code: ____________ Country: _______________
