REQUEST FOR GRADUATE DIPLOMA REPLACEMENT/REPRINT Please allow six to eight weeks for processing and mailing of the replacement diploma. Current graduate diplomas measure 9” by 12”. Your diploma will be printed with the legal name in the official University record at the time the degree was conferred. If your name has changed, please indicate your name at the time your degree was conferred. There is a $20.00 fee for each replaced/reprinted diploma. Please mail this completed form and the Payment Processing Form with your payment information to the address listed below. Name when degree was conferred LAST/FAMILY NAME FIRST/GIVEN NAME MIddLE NAME SUFFIX Current name (if different) LAST/FAMILY NAME FIRST/GIVEN NAME MIddLE NAME SUFFIX NFO Student ID Number: Social Security Number Degree Level I if known D □ Doctoral Date of Birth: E month/day/year Program □ EDucation SpEcialiSt R E-mail Address: □ MaStErS @vt.edu account, preferred □ GraDuatE CertificatE First Term of Enrollment Daytime Phone: REQUI □ fall □ SprinG □ Summer i □ Home □ office □ Mobile □ Summer II year Address where replacement diploma Term of Completion should be sent: □ fall □ SprinG □ Summer i □ Summer II year Campus □ BlacksburG □ HaMpton roads □ national capital Region □ richmonD □ roanokE □ SoutHwest VirGinia □ Virtual city state zip country Number of Diplomas Requested: Return your completed form to: Graduate School Graduate Life Center at Donaldson Brown Virginia Tech (0325) Blacksburg, VA 24061 Fax: 540/231-2039 STUDENT SIGNATURE date Questions? Call 540/231-8636 or e-mail
[email protected] for assistance. REQUEST FOR DIPLOMA REPLACEMENT/REPRINT PAGE 1 OF 1, OcTOBER 2007 PAYMENT PROCESSING FORM Application and diploma reorder fees may be paid via credit card, check, or money order.