Request for Duplicate Diploma
Name_________________________________________________________________________________
Last
First
Middle
Other Names Uses
Address_______________________________________________________________________________
______________________________________________________________________________________
Phone Number (_____) _______________________________Email______________________________
Social Security Number OR V Number _____________________________________Date___________
Degree Awarded________________________________________________________________________
First and Last Year Attended____________________________________________________________
Signature to Release Diploma_____________________________________________________________
Duplicate Diploma 7 to 8 weeks Cost $40.00 EA
__________
Rush Diploma turn-around
5 business day’s additional Cost $75.00 EA
Sample total $115.00
__________
Number Ordered
___________
Fed Ex Mailing $50.00
TOTAL
NO_____ YES___________
___________
OFFICE OF THE REGISTRAR
WESTERN OREGON UNIVERSITY
345 N.MONMOUTH OR 97361
(503)838-8327
(503)838-9696