Diploma Request Form

Diplomas are $25 each. We accept check, cash and credit card. If paying with check, please make check payable to Moody Bible Institute. Money received over cost is accepted as a donation.

Name as you would like it to appear on your diploma (eg. John E Smith II)

Student ID Number OR Last 4 of SSN

Email

Contact Number

Date of Birth

When did you begin taking courses with MBI? (Month/Year)

When did you last take a course with MBI? (Month/Year)

Check all that apply Undergraduate School Student Distance Learning Student Moody Theological Seminary Student

Please Select A Campus Chicago Spokane Michigan Other Extension Site Online

How would you like to receive your diploma? I will pick up diploma ($25 each) Standard Shipping ($25 each)

Credit Card Number

Credit Card Type

CC Expiration

Name on Card

Billing Address

If you wish to call our office with the credit card information rather than enter it here, please enter "will call" above. Once the form is submitted, please call the number you see in the confirmation email.

Additional Notes:

Signature: By typing your name below, you confrm that you are requesting your own diploma. Requests for diplomas on behalf of others is prohibited. You also agree to pay for the selected diploma costs, which includes:

To proceed and submit this request, you must type your full name below.

Signature