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Reissued Diploma Form

Please print, sign, and return the completed form to:

Academic Records
112 Shields Building
University Park, PA 16802-1271

Fax: 814-863-1929

Please print, sign, and return the completed form to:
Academic Records
112 Shields Building
University Park, PA 16802-1271
Fax: 814-863-1929

Identification

*Diploma will be issued with name that is currently on your Penn State record. If your name has changed and you want the reissued diploma with the new name, please submit a name change form and required documentation.
Please enter your name.
9-digit Penn State ID number
Please enter your PSU ID.
*Only enter your SSN if you do not provide your PSU ID number.
(mm/dd/yyyy)
Please enter your date of birth.

Academic Information

Please enter your date of graduation.
Please enter your degree received.
Please enter the name of your major.

Address Where Diploma is to Be Mailed

Please enter your name.
Please enter street address.
Please enter city.
Please enter zip code.
Please enter the country.
Please include area code
Please enter your daytime phone number.
Please enter a valid email address.

Reissued Undergraduate or Graduate Diploma Fee ($40 for each Diploma):

Please enter the number of diploma copies needed.
Multiply the number requested by $40 to calculate the total amount due
Please enter the amount due.

Reissued Medical Diploma Fee ($50 for each Diploma):

Please enter the number of diploma copies needed.
Multiply the number requested by $50 to calculate the total amount due
Please enter the amount due.

Reissued J.D., LL.M., or S.J.D. for Fall 2006 and forward Diploma Fee ($50 for each Diploma):

Please enter the number of diploma copies needed.
Multiply the number requested by $50 to calculate the total amount due
Please enter the amount due.

Payment

Please choose a payment method:


Please review your entries on this form. If all information is entered correctly, please print, sign, and submit the form to the address at the top.

Student Signature

Student Signature: _________________________________

Date: ____________________________

Student Signature: _______________________________________ Date: __________________________

*The requested certificate will be mailed approximately two weeks after receipt of the request.
**Any request received that does not have payment enclosed or credit card information listed, will be returned to the sender.
**Returned checks due to insufficient funds will result in a service charge of $25.00.

Last Revised: 4/6/18