REV 7/14/2020
Diploma/Certificate
Request Form
PLEASE COMPLETE THE BELOW:
First, check the box selecting the product
Second, review shipping timeline
Then, submit paper request with payment
REPLACEMENT OPTIONS:
*DIPLOMA FEES: Check Box Number of Replacement
$20.00 for each Replacement Diploma I would like ____ Diploma(s)
$20.00 for each Replacement Diploma Cover I would like ____ Cover(s)
*Graduation/Commencement fees include 1 original diploma with cover.
CERTIFICATE FEES:
$10.00 for each Certificate I would like ___ Certificate(s)
(Graduate/Post-Baccalaureate Only)
SHIPPING OPTIONS:
DOMESTIC DESTINATION:
*Silver Service (up to 45 days) included w/Replacement Option Fees
INTERNATIONAL DESTINATION (Pricing varies from $90.00 - $250.00)
Silver Service only email registrar@csus.edu for exact pricing
*Monthly orders are submitted in bulk for printing, with delivery upon completion of all
documents submitted, and are mailed out in bulk. Please allow up to 45 days for delivery.
PAYMENT (Options Currently Available):
CHECK/MONEY ORDER PAYABLE TO SACRAMENTO STATE
Mail Option Sacramento State, Bursar’s Office
6000 J Street, Lassen Hall, MS 6052
Sacramento, CA 95819
Submit in Person Sacramento State, Bursar’s Office
Lassen Hall drop box
REQUIRED INFORMATION TO COMPLETE YOUR REQUEST
Please clearly provide the below information in blue or black ink
NAME (Must conform to your legal name on your Sac State record):
First: ___________________ Middle: ___________________ Last: ____________________
Student ID #: _________________
Date of Birth: Month: _____ Day: ______
DEGREE INFORMATION:
Degree Type: _______________________
(BA, BS, MA, MS, etc.)
Graduation: Semester: _________________ Year: ___________
Major: _______________________________________________________________________
CERTIFICATE INFORMATION:
Certificate Of: __________________________
Certificate Issued: Semester: _______________ Year: ___________
ADDRESS FOR SHIPPING INFORMATION ONLY:
Street Name/Number or PO Box: _____________________________________________
City/State/Zip Code: ____________________________________________
Daytime Phone Number: _____________________________________________
Email: _____________________________________________
Total fees included with Diploma/Certificate/Shipping request: $__________________
STUDENT’S SIGNATURE (REQUIRED):
______________________________________________________________DATE_____________________
REV 7/14/2020
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