ADRP __________
Ordered_________
Mailed__________
Request for Replacement Diploma
You must complete all sections of the form. To preserve student privacy, unsigned requests cannot be honored.
The charge for a replacement diploma is $13.00. A check or money order payable to SIUE should be submitted
with your request. Replacement diplomas will not be issued if you have an outstanding financial obligation to
the University. Please note: your diploma will be sent to the address below in approximately 4-6 weeks.
Diplomas will be issued with the original diploma name unless you have submitted a Name Change Request
Form with required documentation to the University.
Name (Please Print):
_____________________________________________________________________________________
Name Under Which You Attended SIUE:
_____________________________________________________________________________________
Student ID Number or Last Four Digits of Social Security Number: ______________________________
Term Degree Was Awarded: _________________________
Degree: __________________________________________
Major: __________________________________________
Signature (unsigned requests will not be honored): __________________________________________
Daytime Telephone: _______________________________________________________
Daytime Email Address: _________________________________________________________________
Address Diploma Should be Sent to:
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Your completed form, with payment, can be dropped off at the Service Center in Rendleman Hall, Room 1309 or
mailed to:
Service Center
Box 1080
SIUE
Edwardsville, IL 62026-1080
Questions? Contact Graduation staff at (618) 650-2282 or (618) 650-2263 or by email at graduation@siue.edu
.
