PARCHMENT REPLACEMENT/REPRINT REQUEST FORM
STUDENT INFORMATION
Student Name: Student ID:
Please select the language to appear on your parchment: English French Gaelic Mi’kmaq
Reason for reprint request: replace lost parchment correct mistake on original parchment acquire an additional parchment
P.O. Box 5300,
1250 Grand Lake Road,
Sydney, NS Canada B1P 6L2
enrolment@cbu.ca
Tel: 902-563-1330
REPRINT INFORMATION
Please print your name as it originally appeared on your parchment:
first name: middle name: last name:
If there was an error in your name, please enter it as it should appear on your replacement parchment:
first name: middle name: last name:
Credential: Date of Conferral:
DELIVERY INFORMATION
Indicate method of delivery: mail courier pick-up
Note: This form must be accompanied by the $21.00 fee. If you wish to have your parchment sent by courier, there will be an additional
charge. Forms submitted by fax and/or those requesting courier service must also be accompanied by a credit card charge form.
Mailing or courier delivery address:
Phone number: Email:
