Penn State Office of the University Registrar

Reissued Diploma Form

Please fill out this online form, print (using "Print Form" button at bottom of page), sign and:
Return to:
Academic Records
112 Shields Building
University Park, PA 16802-1271
Fax 814-863-1929

*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.

*Contact the Dickinson Law School Registrar at 814-863-9938 to request a reissued law diploma.

Address where diploma is to be mailed:

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

x $40 = $

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

x $50 = $
**Payment:

Please review your entries on this form. If all of the information is entered correctly, please print (using "Print Form" button at bottom), sign and submit the form to the address at the top.

Student Signature: _____________________________________ Date: ___________________

*The requested diploma 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.

Revised 7/1/13