Request for Graduate Diploma Replacement/Reprint Please Allow Six to Eight Weeks for Processing and Mailing of the Replacement Diploma
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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. Please complete the information below and submit this document with the corresponding application or form to the Graduate School. Last/Family Name FirSt/given Name Middle Name Suffix Student ID Number: E-mail Address: if known @vt.edu account, preferred O Daytime Phone: F □ home □ office □ Mobile N I ED Please process payment for: IR □ Degree-Seeking ApplicAtion Fee (i.e. MasterS AnD DoctorAl StuDentS) - $45 U Q □ executive MasterS oF BuSiness adminiStrAtion (eMBA) ApplicAtion Fee - $90 RE □ ApplicAtion For SiMultAneouS DegreeS - $45 □ non-Degree-Seeking ApplicAtion Fee (i.e. commonweAlth CampuS AnD non-Degree programs) - $25 □ ApplicAtion For certiFicAte program - $25 □ ApplicAtion For readmission - $25 □ ApplicAtion For viSiting StuDent - $25 □ Diploma reorDer - $20 per Diploma To Pay Via Check or Money Order Enclose your check or money order made payable to Treasurer, Virginia Tech. Checks and money orders must be drawn from a U.S. bank. To Pay Via Credit Card Please complete the following information and sign below. Name as it appears on card: Return your completed form to: S I, the card holder indicated above, authorize payment to be processed. I further Graduate School il understand that this is a non-refundable payment. Payment cannot be processed without a Graduate Life Center A signature, and the application cannot be processed without payment. at Donaldson Brown Virginia Tech (0325) Blacksburg, VA 24061 Fax: 540/231-2039 CarDholDer SignAture date ent Det M y pA Card Type: □ visa □ MasterCarD Expiration Date: month/year The security code is the three-digit code located on the back of the credit card. CRedIT CARD NuMBER SecuRITY COde Questions? Call 540/231-8636 or e-mail [email protected] for assistance. PAYMENT PROcessING FORM PAGE 1 OF 1, DeceMBER 2008.