Diploma Replacement Request

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DIPLOMA REPLACEMENT REQUEST
Walla Walla University Academic Records Office
204 S. College Ave., College Place, WA 99324
TEL: 509-527-2811 EMAIL: recstu@wallawalla.edu

Personal Information

Name*

First Name

Initial (optional)

Last Name

To assist in retrieving your records, please list ALL your previous names.

Email Address*

Phone*

Date of Birth*

These fields are optional, but will help us locate your information.

WWU ID Number

If your ID was 6 digits, add a Zero before the 6 digits..

Social Security Number

optional - to help us find your information

Graduation Year

i.e. 1970

Graduation Quarter

i.e. Spring

Degree (Major)

i.e. History

Do you need to update your name on the Diploma?*

Yes No

Enter your name below exactly as you wish it printed on your diploma.

First Name

Middle Name (optional)

Last Name

Suffix (optional)

Replacement Options

Undergraduate Replacement

Diploma - $20 Diploma Cover - $15

Graduate Replacement

Diploma - $25 Diploma Cover - $20

Total Cost for Replacement $

Delivery Information

Diploma to be Mailed (Allow 3 Weeks) Diploma to be Picked Up in Person (Allow 2 weeks)

Options

Send Diploma via Email Send Diploma via FAX

Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Country

Prefer to pick up Diploma on *

(Allow 2 weeks after request)

Send Diploma to Email Address*

Send Diploma to FAX number*

Attention to*

Payment Information

Credit Card*

Signature

NOTE: ALL DIPLOMAS NEED RELEASE APPROVAL FROM STUDENT FINANCIAL SERVICES. DIPLOMAS WILL NOT BE RELEASED UNTIL ACCOUNT and/or WWU CO-SIGNED BANK NOTE IS PAID IN FULL.

Signature Option*

Typed Mouse/Finger

Name*

First Name

Initial (optional)

Last Name

By typing in your name and clicking on the "Submit" button below, you are providing electronic consent to use your electronic signature and agree that all information you are providing to Walla Walla University on this document is true, complete and correct to the best of your knowledge.

Signature*

[clear]

Use your mouse or finger to draw your signature above

Financial Clearance on

Diploma Mailed on

Diploma Emailed on

Diploma Picked up on

Diploma FAXed on