Replacement Diploma Request
Download a blank fillable Replacement Diploma Request in PDF format just by clicking the "DOWNLOAD PDF" button.
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Complete Replacement Diploma Request with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
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1Replacement Diploma Request
Send Completed Form To:
Date of Graduation: ________________
University of Rhode Island
Enrollment Services Green Hall
mm/yyyy
6 Rhody Ram Way
Kingston, RI 02881 USA
Name Under Which Student Graduated: _____________________________________
Phone: (401) 874-9500
Student ID or Social Security Number or Date of Birth: _____________________________
Fax: (401) 874-2910
Website:
Student’s Date of Birth: __________________
mm/dd/yyyy
Degree(s) Earned: _____________________________
_____________________________
Current mailing address:
___________________________________________
Street
___________________________________________
City
___________________________________________
______________________________
_________________
State
Zip
Phone: ____________________
Print student’s name as it should appear on the diploma:
_______________________________________________________________
Signature ____________________________________________
Date: _______________
mm/dd/yyyy
Please note:
The format of the replacement diploma ordered for you will be similar to that awarded to this year’s graduating class.
The names of the officials currently holding office will be on the replacement diploma. In some cases the names could be
different from the diploma you originally received when you graduated.
The date printed on the diploma will be the degree conferral date verified for your student record.
Send completed form to the address or fax number above.
Rev. 12/2012
The University of Rhode Island is an equal opportunity employer committed to the principles of affirmative action
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