Diploma Order Request Form
The Family Educational Rights and Privacy Act (FERPA) of 1974 prevents the Registrar's Office from releasing materials contained in your student file without your written permission. To comply with FERPA, Western University of Health Sciences requires that requests be made in writing. The Office of the Registrar will not accept any requests by telephone or email.
- Diploma Order Request Form (43.5 KB file)
This file is in PDF format and requires Adobe Acrobat Reader® to view it. To download a free copy, please visit our Plug-Ins page.
The Diploma Order Request form is also available in the Office of the Registrar. If you are not able to download the above form or visit our office to complete the form, requests can also be made in writing with the following information:
Name as it appears on original diploma (please print)
Social Security number or student ID number
Program and graduation date
Daytime phone number, alternate phone number and email address (optional)
Current mailing address (no PO Box addresses)
Please indicate the purpose of your diploma order: duplicate, replacement or change of name.*
Please indicate whether you wish to pick up your diploma at the Office of the Registrar or have it forwarded to you via certified mail. If you wish to pick up your diploma, the Office of the Registrar will notify you by the phone number or email address listed on your request. If you wish for your diploma to be mailed, the Office of the Registrar will forward your diploma via certified mail to the address listed on your request.
Date of request
Requests must have your signature. Requests made by others on behalf of the graduate will not be accepted
Requests may be mailed or faxed. Please allow up to six weeks for processing.
The diploma fee is $60.00 (payment methods include cash, check or money order payable to Western University). If you wish to fax your requests, please submit payment by mail. The Office of the Registrar will not process requests until payment is received.
- Diploma orders are sent via certified mail only. Postage will be paid by the University.
*Note: If you are ordering a diploma due to a change of name, you must submit a copy of the legal documentation that supports your name change with your request. Legal documentation can include the following: naturalization certificate, marriage license, divorce decree, driver's license, social security card or passport. Please clearly state on your request how you wish your new name to appear on your diploma.