Fillable Mail Diploma/Certicate Request (Modesto Junior College)

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Mail Diploma/Certicate Request (Modesto Junior College)

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The Mail Diploma/Certicate Request (Modesto Junior College) form is 1 page long and contains:

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  • 6 check-boxes
  • 15 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Modesto Junior College

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Mail Diploma/Certicate Request
Submit completed form by email to mjcevaluations@mjc.edu, mail, or in-person to the
Enrollment Services Oce.
Today’s Date:
Student Information (Please list your legal name):
First Name: Middle Initial: Last Name:
Student ID: w Date of Birth: Phone Number:
Previous name(s) used on academic records (if any):
Diploma/Certicate Information
Term Granted: Fall Spring Summer Year Granted:
Type Granted: AA AS Certicate Major:
Address to mail Diploma/Certicate:
City: State: Zip Code:
This form is to be used by students WHO HAVE EARNED their Diploma/Certicate in the past two (2) years. If
you need a duplicate Diploma, please see the Duplicate Diploma Request.
You must have a ZERO ($0.00) balance, all fees must be paid, before we can process your request.
Form must be submitted with $5.00 Mail Diploma Fee. Check or Money Order ONLY. Make checks payable to:
Modesto Junior College.
OFFICE USE ONLY
PAID: Yes No Date: MAILED: Yes No Date:
Sta Initials: Date: Comments:
Student Signature: Date:
07/2019_SJB
• MJC Enrollment Services Oce • 435 College Avenue, Student Services Bldg. 1st Floor • Modesto CA 95350 • Phone (209)575-6605
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Mail DiplomaCerticate Request (Modesto Junior College)

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Completed 4 September 2020

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