Request for Replacement Diploma
Please complete, sign, and return this form along with a payment of $10.00 for each replacement diploma to:
Office of the Registrar
University of West Florida
11000 University Parkway
Pensacola, FL 32514
PLEASE NOTE:
1. There is a $10.00 fee per replacement diploma.
The payment must be received prior to processing a request.
Payment may be included with this form, or processed directly with the Cashier’s Office and the receipt
attached to this form.
2. If you need to request notarization of your diploma, please include an additional $1.00 with your order.
3. Confirm that you do not have any financial obligations to the University, which will prevent the processing of your
replacement diploma (holds through the Cashier’s Office or the Financial Aid Office).
4. Replacement diplomas are mailed within 7-14 business days after receipt of the completed request and payment.
PLEASE CAREFULLY PRINT YOUR RESPONSES BELOW:
Date of Graduation: (semester & year)
TYPE OR PRINT YOUR NAME EXACTLY AS IT IS TO APPEAR ON THE DIPLOMA, CLEARLY INDICATING SPACING, CAPTIALIZATION OR SPECIAL CHARACTERS
First, Middle, Last or Maiden Name (Suffix: Jr, Sr, II, IV, etc…)
DIPLOMA MAILING ADDRESS: Do Not Leave Blank, This is Where Your Diploma Will Be Mailed To
City State Zip Country (if other than U.S.A.)
Required Signature:
Student: Date:
RE
GISTRAR OFFICE USE ONLY
Rev. 20171003
Phone: 850-474-224
4
graduation@uwf.edu
