Last updated: 8/29/2018
Century College is a member of Minnesota State. We are an affirmative action, equal opportunity employer and educator. This document can be available in alternative formats to
individuals with disabilities by calling 651.779.3354 or 1.800.288.1978 x 3354
DUPLICATE DIPLOMA REQUEST FORM
Note: Do not use this form to request your original diploma.
You must have already been granted a degree from Century College before requesting a duplicate diploma.
How to Submit: You may bring this form to the Records Office, email us at records@century.edu
, or you may fax us at 651.773.1708.
Only graduates of Century College who wish to request a duplicate diploma may use this form.
Contact Information
Student ID/Star ID or SSN:
Current Last Name First Name MI Former Name(s)
Current Street Address City State Zip Code
Home Phone Cell Phone Email Address
Please print how you would like your name on the diploma.
Name of Diploma:
Select your destination preference and the number of copies: $25.00 fee per Diploma
Number of Copies Destination
Send diploma(s) to the address listed above
Send diploma to the address below
Name/ Organization / Department
Street Address City State Zip Code
Cardholder’s Name:
Cardholder’s Address:
Card Number: Expiration Date:
CVV (3 digit Card Verification Value from back of credit card)
Fee: $25.00 Total Amount Paid:
Cardholder’s Signature: Date:
Records Department
Room 2200, West Campus
3300 Century Avenue North
Phone
: 651.779.3299
Fax:
651.773.1708
click to sign
signature
click to edit
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