UREG (Office of the University Registrar)
P.O. Box 400203
Charlottesville, VA 22904-4203
Replacement/Duplicate Diploma Request Form
Student ID #
Birthdate
Last Name
First Name
Middle Name
Maiden/Previous
Mailing Address
Address
line 1
Address
line 2
City
State
Zip
Country
Phone
Email
Diploma Orders
Fee -- (US dollars only)
Make checks payable to: University of Virginia
Duplicate, Lost or Replacement Diploma Fee:
 $59 for orders to be sent domestically
 $69 for orders to be sent internationally
School of Enrollment
Choose
item
Choose an
an item.
Degree
Choose
Choose an
an item
item.
Semester of
Graduation
Amount enclosed $
Year
Signature
Please send form with payment to:
University of Virginia
UREG (Office of the University Registrar)
PO Box 400203
Charlottesville, Virginia 22904-4203