For each duplicate degree copy requested, please complete a separate form and submit with $10 fee payment
to the Cashier’s Ofce.
Student Name _________________________________________ Prior Last Name_____________________________
Macomb ID or last 4 digits of SSN _____________________________ Phone _________________________________
Street Address _________________________ City______________________ State ____________ Zip____________
*Change of name or address since last attendance requires submission of a driver’s license copy (front and back) to update your academic record.
Title of Degree________________________________________________ Semester/Year Issued:_________________
Student Signature __________________________________________________ Date: _________________________
*We MUST have student signature to release any information
All duplicate degrees will be mailed within 10 business days.
For Records & Registration Ofce Use Only
Processed Date & Initial ______________________________________________
Duplicate Degree Request—Payment Information for Cashier’s Ofce
Submit to Cashier’s Ofce by fax, mail or in person with the following payment methods:
c By Fax: Visa, MasterCard or Discover
c By Mail: Check, Money Order, Visa, MasterCard or Discover
c In Person: Cash, Check, Money Order, Visa, MasterCard or Discover (Note: Cardholder must be present)
Check or Money Order must be payable to Macomb Community College
Card Holder Name____________________________________________________________________
Card Holder Signature ________________________________________________________________
Card Number __________________________________ Exp. Date _____ /_____
SouthCampusCashier’sOce CenterCampusCashier’sOce
G Building, Room 324 G Building, Room 131
14500E.12MileRoad 44575GareldRoad
Warren, MI 48088-3896 Clinton Township, MI 48038-1139
(F): 586.445.7409 (F): 586.226.4754
For Cashier’s Ofce Use Only
Degree veried with Records & Registration before payment is processed.
Session ___________________________ Receipt Number__________________________
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