University of Wisconsin–Madison

Request for Retirement Certificate

  • Requestor's Information

  • 7 digits
  • Retiree's Information

  • Name as it will appear on the certificate.
  • Job Title as it will appear on the certificate
  • Address where certificate should be mailed.
  • Employees who have 20 or more years of service can receive a certificate of appreciation from the Governor's Office. Do you want this certificate?
  • If you answer yes to this question, the employee will retain privileges as outlined in the policy Privileges Retained After Retirement, and in the brochure Privileges for UW-Madison Retirees and Emeriti. There is no need to send an additional email to If you have questions or would like a copy of the brochure, please send an email to
  • Please allow 30 days to process your request.
    If you are picking up the certificate, you will be notified by email when it is ready. Certificates may be picked up at 21 N. Park Street, Suite 5101.
    If you have questions, please contact Donna Seelye at 608-890-3183.