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Replacement Diploma Order Form

This form may be used by former students who may have lost or damaged or need a copy of their diploma. Please complete this form and return it with your payment to the Office of Registration and Records (address below). We will process your request within 7-10 business days after receiving the payment.

  • SUNY Brockport
    Office of Registration and Records
    350 New Campus Drive, Rakov 201
    Brockport, NY 14420
    Ph: 585.395.2531/Fax: 585.395.5392
    Email: degree@brockport.edu

  • INSTRUCTIONS
    *Do not use Internet Explorer
    * Fill out form
    * Submit form (Click "Submit" button after completing form)
    * A receipt will be sent to the email entered on the form
    *If you would like to pick up your diploma, you can bring a print out of the email receipt and bring it with a payment of cash, check or money order to the Office of Registration and Records.
    * If you would like your replacement diploma mailed to you, please print out the emailed receipt and submit it, along with the payment in the form of check or money order, to The Office of Registration and Records.
    * Your request will be processed once the receipt and payment are received by the Office of Registration and Records
    If you have any questions, please email degree@brockport.edu

  • STUDENT INFORMATION
    Please enter your full name below as you wish it to appear on your replacement diploma:

  • Current Name Current Name
  • Must be between 4 and 9 digits.   Currently Entered: 0 digits.
  • Date of Birth Date of Birth * / /
    Pick a date.
  • Your receipt will be sent to the email address you enter here.

  • Daytime Phone Daytime Phone - -
  • Degree Information

    Please enter your degree information.

  • Degree Type *
    Degree Type
  • Date of Degree Date of Degree / /
    Pick a date.
  • Mailing Address- Please send diploma to: Mailing Address- Please send diploma to:
  • Payment Information

    Replacement Diplomas are $15.00 each. Payment may be made by cash, check or money order only. Please indicate below. Cash payments are accepted in person ONLY. We do not accept credit card payments.

  • Payment Method
    Please make check payable to SUNY Brockport. *
    Payment Method
    Please make check payable to SUNY Brockport.
  • Draw or Type
    I understand this is a legal representation of my signature. Clear
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