EmailMe Form - REPLACEMENT DIPLOMA REQUEST

REPLACEMENT DIPLOMA REQUEST

* If your diploma has been damaged or lost, please use this form to request a replacement. "Replacement Diploma" will be printed on the reissued diploma.
* All requests for a replacement diploma must be submitted using this form.
There is a $25 diploma replacement fee (per diploma request) which must be paid before submitting the request form. Payment is made online by selecting the "Pay Now"
link below. A copy of the payment confirmation must be attached to this online request; so process payment prior to completing this form.
* Processing time is at least 10-14 days; during peak periods, the processing time may be longer.
* Submit a copy of your payment confirmation with this form.
* NOTE: If the name now being requested on the diploma is different than the name at the time of graduation (due to marriage, divorce, court order, etc), attach a proof of name change document below such as copy of social security card, court documents, or official marriage license (not the marriage certificate issued by a church, clergy, or other religious entity).

***Questions: Contact the Registrar's Office at 570-484-2008 or registrar@lockhaven.edu***

DIPLOMA REPLACEMENT PAYMENT
$25 fee for each replacement being requested

Pay Now
CURRENT INFORMATION
Student's Current Name
First Middle Last Suffix
Date of Birth
MM / DD / YYYY
Daytime Phone *
### - ### - ####
Please provide a valid daytime phone number in the event questions arise in processing this request.
Social Security Number
The SSN is needed only to locate your records if you are unable to provide your LHU Student ID (below) or the one you provide is incorrect. This field is NOT required. It is encrypted when the form is submitted.
Valid Email *
Current Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
STUDENT INFORMATION DURING LHU ATTENDANCE
Name
First Middle Last Suffix
LHU Student ID
Degree Earned
Graduation Month
Graduation Year
If you earned Latin Honors at the time of graduation, please select from the list. *
Information will be verified before including on diploma.
Did you graduate from LHU's Honor's Program?
REPLACEMENT DIPLOMA INFORMATION
Name to be printed on diploma
First Middle Last Suffix
Provide the name to be included on the replacement diploma.
DIPLOMA RECIPIENT INFORMATION
Provide the name and address to send diploma.
Number of Replacement Diplomas Being Requested
($25 for each replacement)
Name to Mail Diploma
First Last
Address to Mail Diploma

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Payment Confirmation *
Attach a copy of your payment confirmation
Proof of Name Change, if applicable
Electronic Signature *
By typing your name in the electronic signature box, you are certifying that the information on this form is true and correct. Your typed name in the signature box further authorizes Lock Haven University to process this request and serves as the official release required under the Family Educational Rights & Privacy Act.