PortalReplacement Diploma Request Form
Complete this form if you are requesting a replacement diploma due to loss or damage; name change; or need to have a diploma apostilled.
Instructions
- Complete all information requested below and submit via fax (330-941-1408), e-mail (records@ysu.edu). or in person at the Penguin Service Center, Meshel Hall, 2nd floor.
- Once your form is received and information is verified you will receive an e-mail (1-2 business days) with instructions to pay.
- Pay for your replacement diploma using the link sent to you in the email.
- Allow 3-4 weeks for processing, printing, and mailing of replacement diplomas. During times of high volume or printer vendor changes processing can take longer.
Student/Degree Information:
Name:_______________________________________________________________________________________________
First MI Last
Student ID# or SSN:________________________________
Name at time of graduation:_______________________________________________________________________________
(if different from above)
Date of Birth:________________________________
MM/DD/YYYY
Phone Number (required):____________________________________________
Email (required):____________________________________________________
*Name desired on diploma:____________________________________________________________________________
*YSU must have the diploma name on record. If the diploma name is not on record you must submit a Change of Information form and appropriate documentation with this form.
Degree Received:____________________________ Graduation Date:__________________________
Did you receive honors? ___Yes ___No
Please check one of the following:
___ My original diploma was lost, damaged, or destroyed. ___ My name is different than the one on my diploma.
___ My original diploma was never received. ___ I need a replacement diploma for an apostille.
___ Other:_________________________________________________________________________________
Delivery/Pick-Up Information:
Diploma can be picked up at the Penguin Service Center (330-941-6000) in Meshel Hall 2nd floor, during regular business hours. A photo ID must be presented for pick-up.
___ I will pick-up my diploma. Please (circle one) call or email me when it is ready.
___ I cannot pick-up my diploma. I authorize,___________________________________, to pick up my diploma for me.
___ Please mail the diploma to:
Address:_______________________________________________________________________________________
City:___________________________________ State__________________________ Zip:_____________________
Student Signature:_______________________________________________ Date:____________________________
For Records Use Only
Verified:_________ Pymt Email Sent:________ Pymt Rcvd:________ Order Placed:_________ Order Rcvd:________