Replacement Diploma for Late Diploma Name Change

Only complete this form after a staff member from the Registrar’s Office has instructed you to do so and has confirmed that your request can be processed. If you complete this form and the request cannot be completed, a refund will not be issued.

Please note that in addition to completing this online form and submitting payment for a replacement diploma due to a late name change request, you must also complete and submit the “Name Change Request Form,” available on the Registrar’s Office website.

The cost is $105 per copy.

Name (currently on record)(Required)

First Middle Last

Student Number(Required)

Carleton Email Address(Required)

Requested Diploma Name(Required)

First Middle Last

I am an(Required)

Undergraduate Student

Graduate Student

Please read and confirm by checking the following box:(Required)

I confirm that I have spoken with a member of the Registrar’s Office regarding my request for a replacement diploma due to a late name change request.

Please read and confirm by checking the following box:(Required)

I confirm that I have been instructed to submit this form. By submitting this form, I agree that no refund will be issued if this request cannot be completed.

Product Name

Price:

Total

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