Replacement Diploma/Certificate Request Form

Replacement Diploma/Certificate Request Form

Replacement fees - $15.00 for a diploma - $10.00 for a certificate
Student/Degree Information
Name - Type name exactly as you would like it to appear on the award*

First NameMiddle NameLast Name
Student ID #*
Ex: W09123455
Phone Number*
Email*
example@example.com
Date of Birth

MonthDayYear
Date
Type of Award*
Major/Program*
Delivery Information
Type a question*

I will pick-up diploma. Please inform me when it is ready.Please mail the diploma to the address that I listed below.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment Information
Payment Method*

CashCheckCredit Card (Visa/Mastercard/Discover)
Please address check to Columbia College and bring to the Admissions & Records window in the Manzanita Building on campus OR mail to:

Business Services

11600 Columbia College Dr.

Sonora, CA 95370
Please bring cash to the Admissions & Records window in the Manzanita Building on campus.
Name as it appears on card*

First NameLast Name
Credit Card Number*
Expiration Date*
MM/YY
Amount Authorized*
CVC Code*
Three digit number
Credit Card Address*
I, First Name* Last Name* , as a current or former student of Columbia College, by my signature authorize the Admissions and Records Office to process this request. I understand fees are required at the time of request with all financial obligations being satisfied prior to processing. Should I choose to provide payment by credit card, I authorize charge to the credit card listed above.
Signature*

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Payment Information