4/29/2016
INSTRUCTIONS:
1. Duplicate diploma or certificate will NOT be issued if the student account has an active HOLD.
2. Submit completed form accompanied by check or money order payable to Brandman University, to the
following address:
Brandman University
Diploma Department-Duplicate Request
16355 Laguna Canyon Road
Irvine, CA 92618
Note: The fee for a duplicate diploma or certificate fee is $50.00.
3. Allow two to four weeks for delivery of duplicate diploma or certificate.
4. If the original diploma name is different from your current name, and if you want the duplicate diploma issued
in your current name, you must submit two forms of identification so your permanent record is changed to
your current name.
5. Duplicate diploma or certificate will bear the signatures of the current officials of the University.
Status of diploma or certificate order, please email diploma@brandman.edu
Please Print:
Name on original diploma/certificate:
Requested (New) diploma/certificate name:
Check box to update
permanent record
Student ID # or last four digit of Social Security #:
Date of Birth:
Month/Year
Degree/Certificate awarded:
Degree/Certificate
received (i.e. BA):
Mailing Address-Street:
City:
State:
Zip Code:
Day phone:
Cell phone:
Brandman
Email address:
Comment (eg indicate accent mark to diploma/certificate name):
Student Signature: Date:
For Office Use Only
Payment: Check Money Oder
Date form
received:
Date Processed:
Date mailed:
Hold verified
Degree/certificate verified
BRANDMAN
UNIVERSITY
16355 Laguna Canyon Road
Irvine, CA 9261
Duplicate Diploma/Certificate
Request Form
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