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REQUEST FOR DUPLICATE DIPLOMA Fee: $25.00 Per Diploma |
California State University, San Bernardino Office of Records, Registration & Evaluations 5500 University Parkway, San Bernardino, CA 92407 (909) 537-5219 Fax (909) 537-7021 |
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Please send [How Many] duplicate diploma(s) to the following address: | |
| Last Name: | First: | Middle Initial: |
| Street Address: | ||
| City: | State: | Zip Code: |
| Country (if not in the US): | ||
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Please tell us EXACTLY how you would like your name to appear on your diploma(s): (If name is different from our records, supporting documentation is required; i.e. copy of marriage certificate, new driver's license, SSN.) (Please print clearly.) =>_________________________________________________________________________________ |
| Student's Name: | Student ID No.: |
| Date of Birth: | Date of Graduation: |
| Degree Received and Major: | |
| Phone number should we need to reach you: | Home: ( ) | Work: ( ) |
| Student's Signature:_____________________________________________Date:___________________ |
| Office Use Only: # of copies:____________ $_____________ Check #_____________ Rec'vd By______________ Date____________________ |