Application for Diploma Re-Order

Please complete all fields in order to process in a timely manner. Diploma orders and re-orders are only processed in May. This form is a request to re-order a duplicate copy of your diploma to be mailed to the address listed below.

The cost for a duplicate copy of your diploma is $50.00. Request may be paid by cash if paying in person, cashier’s checks or money order. To pay by Visa or Mastercard, please contact the Cashier’s Office at 601-977-7715 to receive a receipt number and payment date prior to submitting this request.

Payment details

Receipt Number:

Payment Date:

Month

Day

Year

Student ID: *

Name: *

Name to appear on my diploma: *

Local Phone:

Permanent Phone: *

E-mail: *

Address: *

Country *

Address 1 *

Address 2

City *

State *

ZIP code *

Original Graduation Date: *

Month

Day

Year

Major:

Degree: *

Signature: *

I consider myself a qualified candidate for graduation at the time indicated below and upon completion of my remaining requirements. By typing my name below, I am submitting a legal signature confirming that I acknowledge and agree to the information provided.

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Application for Diploma Re-Order