Request for Replacement Diploma
Records Office - Middle Tennessee State University - Murfreesboro

There is a $10 fee for a replacement diploma.  Payment may be made by mail to the address below or in person.  Please allow 4 to 6 weeks for processing.

Social Security Number - - -    Date of Birth -

Please enter name as shown on MTSU records:

Last Name -

First Name -

Print name as desired on diploma -

Date of Graduation -  

Degree Earned -  Major -

Address where the diploma should be mailed:

Number and Street -

City -

State -  Zip -  

Please provide your Work Phone Number - ( ) -

Please provide your Home Phone Number - ( ) -

Signature                                                                                              Date                                              

PRINT THIS FORM AND MAIL

Mailing Address:

Records Office
Cope Administration Bldg.
MTSU
1301 East Main Street
Murfreesboro, TN 37132

Should you have any questions regarding these procedures, please call (615) 898-5170.