Duplicate Diploma Request Form

The IUPUI Office of the Registrar will process duplicate diplomas requests for degrees awarded at the IUPUI campus. Visit the Office of the Registrar at the Indiana or Purdue University campus that awarded your degree for their procedures and cost of ordering a duplicate diploma. Your name will appear on the diploma in the same format as it is stored in the Office of the Registrar records. Students whose names require editing or have been legally changed should file a Request for Change of  Name form. Legal documentation, such as a copy of a social security card, marriage certificate, or official court document, must be provided to support the name change.  

Your Information:
Name	_______________________________________________
Student Ten Digit ID Number / or SSN	_______________________________________________

Phone	( _____) _____-________	E-Mail _______________________________
Degree	_____________________	School _______________________________
Degree Date	_____________________	Campus ______________________________

Reason for Request: _______________________________________________________________

_________________________________________________________________________________

Mail To:
Name	_______________________________________________________________
Street	_______________________________________________________________
City	________________________________  State ________ Zip ______________

______________________________________________________________________
Signature

____________________________
Date

_____ My check is enclosed (payable to IUPUI)

_____ I want to pay by credit card: _____ Visa _____ MasterCard _____ Discover

__________________________________ Card Number

____________________ Expiration Date

Payment must accompany all requests. Fees currently in effect for this service (including domestic postage) are:

IU Undergraduate & Graduate	$ 35.00
IU Law, Medicine, DDS	$ 50.00
Purdue	$ 35.00

Please add an additional $10.00 if overseas mailing is required.