DUPLICATE D
IPLOMA
REQUEST F
ORM
LLU
ID#
or
Social
Security
Number:
Name
on
Diploma:
Telephone
Number:
E-mail
Address:
Degree
and
Major:
Date
Awarded:
Is this diploma being reordered due to a name change?* Yes No
*Please note, duplicate diplomas with new names can ONLY be ordered once a Change of Name Request has been submitted to our office. Contact
diplomas@llu.edu for the Change of Name Request form.
What
is
your
new/updated
name?
REQUEST INFORMATION
Please indicate if you would like your duplicate diploma mailed or held for pick-up. Diplomas are sent
certified mail via restricted delivery which requires your signature to receive.
MailHold for pick-up
Name:
Card Number: Exp.
Date:
Please
note the Office of University Records must obtain authorization from Student Finance and Loan
Collections in order to release degree information.
Signature:
Date:
If you have any questions please email
diplomas@llu.edu
Phone: (909) 558-4508 | Fax: (909)
558-0340
Address:
Quantity of duplicate diplomas requested. The cost of each diploma is $100.00.
This fee is non-refundable and must be received before request is processed.
PAYMENT INFORMATION
We accept check or credit card (VISA, MasterCard or Discover) payment. Please make checks payable to
Loma Linda University and mail to University Records, Loma Linda University, Loma Linda, CA, 92350.
Hand signature required.
click to sign
signature
click to edit
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