OFFICE OF ADMISSIONS AND REGISTRATION
REQUEST FOR REPRINT OF DIPLOMA
Date:
Empl ID#:
Student Name:
Last First Middle
Degree/Diploma Earned: Term Awarded: _
Degree/Diploma Earned: Term Awarded: _
Degree/Diploma Earned: Term Awarded: _
Wolfson Campus
Eduardo J. Padrón Campus
Number of diplomas requested: Total due: $
_____I choose to receive my diploma by mail.
Mailing Address:
Street Address City State Zip Code
I choose to pick up my diploma in person.
Instructions: By your signature below you acknowledge the amount of $20.00 due for each diploma reorder
which must be paid in full before the diploma can be printed and mailed to you. Take this form to the Bursar’s
Office and pay the amount due. Bring the form and paid receipt back to the Admissions & Registration office. You
will be given your original receipts and a copy of this form. Your diploma document will be mailed to you within
seven business days.
Note: If you are picking up the diploma on behalf of someone else, a notarized request letter and the picture ID of the
student is required.
Student Signature: Date:
FOR OFFICE USE ONLY
Gov/state picture ID will be required A&R Form – Rev 5/19
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
