University Registrar : Application for Replacement Diploma

IMPORTANT: This form cannot be submitted electronically. Please type in the required information, print and sign the form and have it notarized. Mail the completed form to the address below:

Office of the Registrar
Columbia University
210 Kent Hall, MC 9202
1140 Amsterdam Avenue
New York, NY 10027

The Office of the Registrar will order replacement diplomas if the original has been damaged or lost or if there has been a change of name. You must provide proof if your name has been changed by filing a Name Change Affidavit .

Enclose with this application a $100.00 check payable to Columbia University, as well as copies of two (2) ID proofs from the following choices: passport; birth certificate; driver's license or social security card. In addition, verification of your signature by a Notary Public is required.

Replacement diplomas display the signatures of the current Columbia President and Dean of your school but show the original date of the award.

Columbia University in the City of New York

Application for Replacement Diploma

Print Form

Name On Original Diploma

Last:

First:

Middle:

New Name

Last:

First:

Middle:

Identification

CUID:

Date of Birth M/D/Y
Month	Day	Year

Columbia Schools and Degrees

School	Degree	Date of Award-M/Y
School 1	School 1 Degree	Month of Award	Year of Award
School 2	School 2 Degree	Month of Award 2	Year of Award 2
School 3	School 3 Degree	Month of Award 3	Year of Award 3

Contact Information

Email:	Phone:
Fax:
Address Line 1:
Address Line 2:
City:	State/Province:
Postal Code:	Country:

I hereby certify that my original diploma was lost or damaged or I have changed my name.

Student's Signature

Notary's Signature

Date

Notary Stamp:

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Application for Replacement Diploma

Columbia University in the City of New York

Application for Replacement Diploma