Diploma Request Form

Diploma Request Form
Student Information
Name*

First NameMiddle NameLast Name
Student ID # (last 4 of your social)*
Date of Birth*

MonthDayYear
Phone Number*

Area CodePhone 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 NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date and Signature
Date*

MonthDayYear
Date
Signature*

Clear
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

USDPayment

Payment Methods

Credit Card

Cash App Pay

Should be Empty:

Diploma Request Form

Student Information

Delivery Information

Date and Signature

Payment Methods