Fillable Diploma Copy Request Official & Unofficial Copies of (University of North Texas Health Science Center)

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Diploma Copy Request Official & Unofficial Copies of (University of North Texas Health Science Center)

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Diploma Copy Request
Official & Unofficial Copies of Diploma
University of North Texas Health Science Center
Office of the Registrar, SSC 240
3500 Camp Bowie Blvd.
Fort Worth, TX 76107-2699
(817) 735-2201 / Fax (817) 735-0448
registrar@unthsc.edu
NOTE: To request a Duplicate/Replacement Diploma please visit our Registrar's Office Forms Page.
Questions regarding data collected may be directed to the Registrar. (HB 1922)
Student ID OR Social Security Number
Date of Birth
Program
Texas College of Osteopathic Medicine
Graduate School of Biomedical Sciences
School of Public Health
School of Health Professions (PA, DPT, & MSLS)
System College of Pharmacy
Last Name First Name Middle Name
E-mail
Daytime Telephone Number
Other Names Used While Enrolled at UNTHSC
Graduating Year
I would like to request:
Number of copies:__________
Delivery Method:
I would like to pick up my documents in person.
(Please bring a photo ID to the front desk of Student
Affairs for document pick up.)
Mail to: ___________________________________________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
Fax to:
Attn:____________________________________
Fax Number: _____________________________
Email to:
_____________________________________________________
I certify that I am the person whose name appears on the name line of this form,
and do hereby authorize release of my academic records via the method listed above.
_______________________________________________ ____________________
Signature Date
For Office Use Only
Date Request Completed__________
Revised 09/30/2020
Unofficial Diploma Copy
Copy of diploma printed on plain white 8.5 X 11 paper or in PDF
format. Unofficial copies do not include seal, certification, and
registrar's signature and can be emailed as a PDF or faxed.
Unofficial Diploma Copy
Number of copies:__________
Please allow 3 - 5 business days for request completion.
Official Diploma Copy
Copy of diploma printed on plain white 8.5 x 11 paper.
Official copies include seal, certification, and registrar’s signature
and are only available via mail or pick up in person.
Official Diploma Copy
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Diploma Copy Request Official & Unofficial Copies of (University of North Texas Health Science Center)

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Completed 2 February 2021

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