DUPLICATE DIPLOMA ORDER FORM

Print
Name
(Please note: Duplicate diplomas are issued with the name that appears on your academic record at the time of graduation.)
WKU ID: Date of Birth:
Address:

Daytime Phone:
Degree Earned: Date of Graduation:
Reason for Request:

Signature Date

PLEASE NOTE: There is a $15.00 charge for each diploma ordered.
Normal delivery is 6-8 weeks.
Please print this form, provide the necessary information and mail/fax to:

Cheryl Hills
Office of the Registrar
Western Kentucky University
1906 College Heights Blvd #11017
Bowling Green, KY 42101-1017
Fax 270-745-4830

Mastercard, Visa and Discover Cards Accepted
Credit Card Type/Expiration Date:
Number:

FOR OFFICE USE ONLY
Receipt Number
Date Mailed

Questions regarding duplicate diplomas may be directed to (270) 745-5411 or to cheryl.hills@wku.edu.

PLEASE NOTE:	There is a $15.00 charge for each diploma ordered. Normal delivery is 6-8 weeks. Please print this form, provide the necessary information and mail/fax to:
	Cheryl Hills Office of the Registrar Western Kentucky University 1906 College Heights Blvd #11017 Bowling Green, KY 42101-1017 Fax 270-745-4830
	Mastercard, Visa and Discover Cards Accepted Credit Card Type/Expiration Date: Number:
FOR OFFICE USE ONLY Receipt Number Date Mailed