Replacement Diploma Order Form

Replacement Diploma Order Form
Office of the Registrar
Phone: 251.626.3303
Fax: 251.625.1035
Email: registrar@ussu.edu
Please allow 8 to 12 weeks for delivery of replacement diploma. Credit card payments will have a 3% processing fee added.. Replacement Fees: Parchment Copy (8 1/2" x 11")
Name (as it should appear on the diploma)
Name

First NameMiddle InitialLast Name
Telephone Number:
Format: (000) 000-0000.
Student Identification #:
Date of Birth:

MonthDayYear
Date
E-mail Address:
example@example.com
Degree Received:
Date Degree was conferred:

MonthDayYear
Date
Replacement Diploma
Send Diploma To:
Name:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Payment information

Credit Card transactions will include a 3% processing fee.
Calculation

USDThe replacement fee is $35 plus a 3% CC processing fee

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country