University of Maryland University College
Office of Student Affairs
REPLACEMENT/DUPLICATE DIPLOMA FORM
Name
Student I.D. number _______________________________________________________________
Address_________________________________________________________________________
Street Number
Telephone: Daytime (
City
)
State
Evening (
Zip
)
E-Mail address ___________________________________________________________________
Date of birth
Type of degree
Date awarded
Please check one:
 Replacement diploma - please return original. If original is not available, this form must be
notarized (below).
 Duplicate diploma - will indicate “duplicate.” State reason for request for a duplicate diploma
(I.e. lost, damaged, destroyed)
Signature
Date
Notary’s signature
Date
Fee: $50. Make check payable to UMUC or complete credit card information below.
Type of credit card ______ MasterCard
Credit card number
______ VISA
Expiration date
Cardholder’s name ________________________________________________________________
UNIVERSITY OF MARYLAND UNIVERSITY COLLEGE
3501 University Boulevard East, Room 2229, Adelphi, MD 20783-8075
Phone: 800-888-UMUC Ext. 7236 Fax: 301-985-7889
E-Mail: registrar@umuc.edu Website: www.umuc.edu
Rev: 02/04 A:\Records Forms\Diploma_