Replacement Diploma Name Change
Clemson University will provide a replacement or additional diploma to graduates of the University for a fee of
$50.00 per diploma. Replacement and additional diplomas are printed on existing paper stock at the time the order
is processed and are engraved with signatures of current administrators and officials. As such, a replacement or
additional diploma may not be an exact duplicate of the diploma originally issued. Please allow six to eight weeks
from the time your payment is processed for delivery of a replacement or additional diploma.
Please provide the following information and a copy of a social security card displaying your new legal name.
If you are an international student, please provide a copy of a valid passport which is stamped with a student visa.
Other documents, such as driver’s license or notarized statements, are not acceptable.
Graduate’s full name as listed on the academic record:
__________________________________________________________________________________________
First
Middle or Maiden Last Suffix
Graduate’s NEW full name as it should be listed on the academic record:
__________________________________________________________________________________________
First
Middle
Last Suffix
Mailing Address: ___________________________________________________________________________
Street/P. O. Box
__________________________________________________________________________________________
City/Town
State Zip
Telephone: (______)______________________ E-mail: ____________________________________________
CUID Number or Social Security Number: _________________________________Date of Birth: ___________
Major at Clemson: __________________________________________________________________________
q
Bachelor’s
Degree Awarded: q
Master’s
qPhD
Date of graduation:_________________
Method of Payment:
q
Check
Month/Year
q
Money Order
Check or money order should be made payable to Clemson University. Check number: ________
Graduate’s Signature: ________________________________________________________________________
Return this form to:
Enrolled Student Services Office
104 Sikes Hall
Box 345125
Clemson, SC 29634-5125
Office of Records and Registration
rev. 02/16