FRESNO CITY COLLEGE
REQUEST FOR DIPLOMA OR CERTIFICATE REPLACEMENT
STUDENT INFORMATION
NAME: OTHER LAST NAME:
Last First If different when attending
ADDRESS: STUDENT ID#:
Number and Street (APT#) or Social Security #
PHONE #:
City, State Zip Include Area Code
DOCUMENT INFORMATION
TYPE OF DIPLOMA/CERTIFICATE TO BE REPLACED:
DATE DIPLOMA/CERTIFICATE WAS AWARDED:
REPLACEMENT DELIVERY METHOD: US MAIL COUNTER PICKUP
IF US MAIL – SEND REPLACEMENT TO:
Number and Street (APT#)
City, State Zip
IF COUNTER PICKUP – PHONE # TO CALL WHEN READY:
Include Area Code
NOTE: See below - Proof of Payment MUST accompany your Request
Student’s Signature Date
PAYMENT INFORMATION
Replacements of all Diplomas may be paid to the Fresno City College Business office in the amount of
$10.00. The receipt issued by the Business Office must be provided to Admissions and Records with this
signed request.
Replacements of all Certificates may be paid to the Fresno City College Business office in the amount of
$10.00. The receipt issued by the Business Office must be provided to Admissions and Records with this
signed request.
Diploma_Certificate_Replacement_Request_ACC_02052018
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signature
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