Request for a Replacement Diploma This form is used to order a replacement diploma when the original is lost or an official copy is needed If you graduated in the past year and did not receive your original diploma, please contact the Office of the Registrar at Registrar@stkate.edu to request a complimentary replacement Instructions: • Fill out this form completely • Make copy of photo ID (St Kate’s or government-issued ID) • Select payment method (please check one): □ □ • I have enclosed a $50 check or money order payable to St Catherine University I have pre-paid with a credit card using Marketplace uStore: https://katepay.stkate.edu/C20594_ustores/web/index.jsp Send your signed form, a copy of photo ID, and payment to the address below If you pre-paid with a credit card, you may scan and email this form and copy of ID to Registrar@stkate.edu Last Name: _ First Name: Middle Name: Previous Name(s): Date of Birth: / / Student ID (if known): SSN: XXX-XX- Email: Phone: ( ) Address: City: State: Zip Code: Term and year last attended: _ College/Campus attended: _ Degree awarded: Latin Honor: Your name as you want it to appear on your diploma: _ If different from above address, please indicate where you would like your replacement diploma mailed: Name of recipient: _ Address: City: State: Zip Code: Signature: _ Date: St Catherine University, Office of the Registrar 2004 Randolph Ave, Derham Hall 229 Saint Paul, MN 55105 Phone: (651) 690-6531 Email: Registrar@stkate.edu