UREG: Registrar's Office at the University of Virginia
   

Diploma Request Form

 

Student ID#: Birthdate: / /
Full Name:

, , -

 (Last) (First)  (MI) (Maiden or Previous)

Street# /Box# /Apt#:

Address 2:

City: Zip: Country:

Phone #: ( )- - E-mail #:

Diploma Orders: - Original: Copy: Replacement: Sent orginal back, reordered:

Original Diploma Fee: $9 for domestic mailing, $19 for international mailing
Duplicate, Lost or Replacement Diploma Fee: $50 in addition to $9 for domestic mailing, $19 for international mailing (US Dollars only)
Make checks payable to: University of Virginia (US dollars only). Amount enclosed $ Diplomas will not be mailed without payment in advance. (No mailing charge for DMP/Honors participants)
Are you in a College Distinguished Majors or Honors program? Yes No

School of Enrollment:

Degree:

Semester of Graduation: Spring Summer Fall Year:

I authorize the issuance of my diploma to all parties indicated on this page.

Signature: __________________________________________________________________________

Mail form to:  University of Virginia 
  UREG (Office of the University Registrar)
  PO Box 400203 
  Charlottesville, Virginia 22904-4203
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