Diploma Reorder Form - OneStop Enrollment Services

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Diploma Reorder Form
Enrollment Services
A replacement or duplicate diploma has a fee of $10.00. Please complete this form and submit payment to the Cashiers
office. Attach the receipt to this form and submit to the OneStop department for processing. If this form is being submitted
by mail, complete this form and attach your check for $10.00 made payable to Florida International University and send to:
Florida International University
Attn: Office of the Registrar
11200 SW 8th Street
Miami, FL 33199
*Please allow 6-8 weeks for Diplomas to be reordered.
Name: _______________________________________________________ Former Name (If Applicable): _______________________________________________
Panther ID: _________________ Date of Birth: _______________ Last four digits of SS#: ____________ Number of copies requesting: _______
Current E-mail address: ______________________________________________________ Phone Number: __________________________________________
Academic College:____________________________________________________________________________________________________________________________
Name (As it should appear on the diploma): _______________________________________________________________________________________________
(Note: If your name has changed since you graduated and you would like your new name printed on the diploma, please provide a
change of name form along with the appropriate documentation.)
Diploma Mailing address: _________________________________________________________________________________________________________________
*Please initial if you would like to pick up your diploma__________. You will be notified once the diploma is ready.
___________________________________________________________________________________________________
X Student Signature
Section to be completed by Graduation Department
_____________________________
Date
*Diploma holds: PKG RSR SBC SCA SCH SPX STX
*Ordered on: ________________ by (Employee’s Initials): _____________ Due: ___________
*Payment Amount Attached: $_________________
Check_______ # __________________________
Money Order_______ # __________________________
Receipt _______ # __________________________
*Degree of Distinction (If applicable, circle one):
Honors
High Honors
Highest Honors
*Did the student request a transcript? Yes No
Cum Laude
Magna Cum Laude
Summa Cum Laude
*Comments:___________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________
******************************************Diploma Release******************************************
Mailed: Date ______________________
Picked Up: Date ____________________
Florida International University · Enrollment Services
Modesto A. Maidique Campus · 11200 SW 8th Street · PC 130 · Miami, FL 33199 · 305.348.2320
Biscayne Bay Campus · 3000 NE 151st Street · AC1 100 · North Miami, FL 33181 · 305.919.5750
OneStop.FIU.edu
Updated: 10/29/13 KT/OneStop