Diploma Request Form
Student Information
Name
*
First Name
Middle Name
Last Name
Student ID # (last 4 of your social)
*
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
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31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
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2015
2014
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2012
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Check the reason why you wish to replace your diploma.(Replacement are $10.00 plus mailing fee) If you NEVER received your diploma, you will only be responsible for paying mailing fee ONLY if you wished to have it mailed.
*
Lost, damaged, or destroyed.
Never received the original diploma.
My name is changed.
I need a new diploma.
Delivery Information
Method of Delivery
*
I will pick-up diploma. Please inform me when it is ready.
I cannot pick-up my diploma. I authorize the person below to pick up the diploma for me.
Please mail the diploma to address that i mentioned below.
Name
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date and Signature
Date
*
-
Month
-
Day
Year
Date
Signature
*
Total Amount Due
Must enter the total amount due to process your request. For example, If your total amount is 0, enter 0; If your total amount is 10 enter 10 and make your payment using the payment method listed below. FOR CASH APP $SMSCHOOL
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USD
Payment
Payment Methods
Credit Card
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Submit
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