Request for Duplicate Diploma
Diploma Fee: $15.00 per duplicate Copies Requested ______________
Student ID: _________________ Date of Birth: _________________
______________________________ ______________________________ _____________________________
First Name Middle Name Last Name
Your name on your duplicate diploma will appear exactly as it does on your original diploma. If your name has changed since the issue
of your original diploma, please submit a Name Change Form to Enrollment Management.
Phone: _________________________ E-mail: ________________________________________________________
Address __________________________________ City: ___________________ State: _____ Zip:_______________
Term Graduated: ___________________________
Degree Earned: BA BS MA MS MBA
Major ____________________________________ Concentration/Emphasis: ________________________________
Diplomas will be sent to the mailing address on file with the University. Please verify your mailing address at CI Records.
(myci.csuci.edu). If you need to update your mailing address, but are unable to access online, please complete the change of address
section below. Duplicate diplomas will be mailed within 4-6 weeks.
CHANGE OF MAILING ADDRESS
New Address New Phone Numbers
Street: _______________________________ Home Phone: ____________________________
City: _______________________________ Cell Phone: ____________________________
State: ____________ Zip: _______________ Business Phone: _________________________
Please complete and submit this form by mail or in person to Student Business Services in the
Enrollment Center, Sage Hall, with appropriate fee. If you have any outstanding obligations to the
University this request will not be processed until they are resolved. Records cannot be released
without the written consent of the student, so please be sure to sign this form below.
Student’s Signature ______________________________________________ Date ___________________________
Administrative Use Only-Enrollment Management/ Student Business Services
__________ Fee $15.00 Check __________ Cash __________ By: _______________ Date: ___________
(Student Business Services)
***PLEASE SEND COMPLETED APPLICATION TO THE REGISTRAR’S OFFICE
Administration Use Only-Registrar’s Office
Processed by: _________ PS Update: __________ Student Notification: __________
(Staff Initials) (Date) (Date)
Revised: 4/8/2019
Enrollment Management
Registrar’s Office
One University Drive
Camarillo, CA 93012
Phone: (805) 437-8500
