Request for Duplicate Certificate

Request for Duplicate Diploma
The Request for Duplicate Diploma form should be completed by a graduate who wishes to request a replacement Diploma from the administrative office.

Graduates should complete this form, attach a clear photocopy of a valid goverment issued picture identification and submit the $50.00 fee via credit card.

Normal completion time is a minimum of 4 weeks.
Graduate Name:*

First NameLast Name
Last 4 of your SSN:*
Last 4 digits of your SSN:*
Campus:*
Program Name:*
Date Graduated:*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail Address*
Reason for the Request:*

Misspelled/Incorrect Name - The original certificate must be returned before a replacement is issued. The $50 fee will be charged if the name on the original certificate matches the name in the Center's SIS at the time the original certificate was issued. The fee will be waived if the name on the original certificate does not correctly match the name as it appears in the SIS at the time the original certificate was issued.Original Certificate was lost/destroyed/stolenName was legally changed - Include a copy of the original certificate, the Change of Name Form including appropriate supporting documentation.Other
Original Certificate:

Upload a File

Cancelof
I would like to:*

Pick up my duplicate DiplomaHave the Admin Office mail it out
Signatures on the duplicate Diploma may not match signatures on the original Diploma. The duplicate Diploma will have a statement on the bottom stating that the Diploma was "re-issued". An email will be sent to notify you once your request has been completed.

PAYMENT:

Duplicate Diploma$50.00

Subtotal $0.00Tax $0.00Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Graduate's Signature*

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Administrative Office Use Only
Notes:
Date Completed:
Was the graduate emailed?
Completed By:
Should be Empty:

Request for Duplicate Diploma