SID Number (if known): Social Security Number:
Student Name:
Previous Name(s):
City: State: Zip Code:
Email: Phone Number:
Please list the degree/one-year certificate you’re requesting to be reprinted:
The cost for reprinted diploma(s) is $15/diploma
Certificates (20-44 cr) and short-term certificates (0-19) are posted on the transcript, but not provided a printed diploma. For GED, please visit ged.com.
1.) Year:
2.) Year:
3.) Year:
4.) Year:
5.) Year:
I’m requesting the above diplomas be reprinted and mailed to the address listed above. I have attached a copy of payment receipt.
Signature: Date:
This request can be submitted in person or by US Postal Service. Requests will not be accepted via email or fax.
Cash, Check, Money Order, Visa/Mastercard
In Person:
H Building, Hawk Central
2600 N. 20th Ave.
Pasco, WA 99301
OR Check or Money Order
Columbia Basin College
Attn: Student Records
2600 N. 20th Ave., MS-H4
Pasco, WA 99301
Last First Middle Initial
We are temporarily unable to accept this form 'In
Person' while our campuses operate remotely.
Please submit the completed form via USPS with
payment enclosed (check or money order)
or from your CBC student email to
If emailed, please call the Cashier at
509-544-2268 to complete payment.
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and afrmative action. CBC does not discriminate on the basis of race, color, creed, religion,
national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military status, or the presence of any sensory, mental, or
physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be referred to the Colleges Title IX/EEO
Coordinator: Camilla Glatt, Vice President for Human Resources & Legal Affairs, 2600 N. 20th Avenue, Pasco, WA 99301, telephone (509) 542-5548, email cglatt@columbiabasin.edu. Individuals with disabilities are encouraged to participate in all college spon-
sored events and programs. If you have a disability, and require an accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
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