OFFICE OF THE REGISTRAR
Request for Duplicate or
Waterloo, Ontario, Canada N2L 3G1
519-888-4567, ext. 35378 | fax 519-746-2882 | uwaterloo.ca/registrar
Replacement Diploma
GRADUATE STUDIES
Waterloo, Ontario, Canada N2L 3G1
519-888-4567, ext.35411 | fax 519-746-3051 | uwaterloo.ca/graduate-studies
Print clearly and complete all areas below.
Important notices:
Complete this form if you are a graduate wishing to obtain a duplicate copy of your diploma or wishing to replace a lost, damaged, or destroyed diploma.
Send requests for undergraduate diplomas to the Office of the Registrar and requests for graduate diplomas to the Graduate Studies Office; both are in Needles Hall.
Enclose the appropriate processing fee. The cost per duplicate or replacement diploma is $20.00 plus any additional mailing costs. See the section “What should
we do with your order?”
Normal processing time is 7 days.
Waterloo student identification number ____________________________________
Complete the section below to order a duplicate or replacement diploma.
Duplicate diploma – The word DUPLICATE will be printed on the diploma. Select diploma type: Undergraduate
Master’s
PhD
The number of Duplicate diplomas requested equals ________.
Replacement diploma – Select diploma type:
Undergraduate
Master’s
PhD
One replacement diploma will be issued.
Select which option is applicable:
Original diploma was lost or damaged or destroyed. A Statutory Declaration form must be completed for a replacement
diploma if the original diploma is not attached. This form is on page 2.
Yes
No
Indicate if the original diploma is enclosed.
Official name change (A copy of an official document must be submitted with this request. Acceptable documents include a
copy of a passport or marriage certificate or birth certificate or court document.)
The total number of Duplicate and Replacement diplomas requested equals ________.
What should we do with your order? Select one.
Hold for pick up (Identification is required for release.)
Mail to the following address (A $10.00 mailing charge applies to Master’s and PhD diplomas.)
Send by courier. Additional mailing charges are:
$10 if in Ontario
$20 if in other Canadian provinces
$25 anywhere in the United States
$35 international (outside Canada and the United States)
Mailing address: Street ____________________________________________________________________ City ____________________________
Province or State ______________________________ Country ____________________________ Postal or zip code ___________________
Record identification data:
Print your full name below in upper- and lower-case letters as it appeared on your original diploma.
Last name _______________________________________________________________________________________________________________
First name __________________________________________________ Middle name(s) _______________________________________________
Last name at last attendance ________________________________________________________________________________________________
Degree or Diploma ________________________________________________________________________________________________________
Birth date (day) _________ (month) _________ (year) _________
Confer date (day) _________ (month) _________ (year) ___________
I hereby certify that all of the above statements are correct and complete.
Signature _______________________________________________________________________ Date ____________________________________
Email _________________________________________________ Phone number (area code) ________ (number) ___________________________
Payment information:
Total amount $ __________________________________________
Office use only
Cash
Cheque
Name on credit card ______________________________________
Amount ________________________
Debit
Credit card number _______________________________________
Credit Card
Received by _____________________
WatCard
Credit card expiry date (month) __________ (year) ___________
Date received ___________________
Card holder’s signature ___________________________________
Page 1