Butler University Diploma Order Form 
Butler graduates may order a replacement diploma by completing this form. They may also submit an order in a written request by mail, email, or fax instead. The cost of a replacement diploma is $50. 

Mailed requests should include a check made payable to Butler University and may be addressed to:

 Registration and Records 
 Jordan Hall, Room 180 
 4600 Sunset Avenue 
 Indianapolis, IN 46208 

 Faxed or emailed requests can be submitted with credit card information to 317-940-6539 or to registrar@butler.edu.  
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Graduate's name at the time they attended Butler:   *
Graduate's date of birth:    
 *
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 How the name should be printed on the Diploma:    
 *
Year of Graduation:  *
Mailing address where the diploma should be sent:  *
Phone Number:  *
Email Address:  *
Payment:  *
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