Fillable RE-ORDER DIPLOMA-FULL PAGE

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RE-ORDER DIPLOMA-FULL PAGE

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Date Requested
_______/______/_______
The Fee is $25.00
CERRITOS COLLEGE ADMISSIONS & RECORDS
OFFICE
RE-ORDER FORM FOR DIPLOMA/CERTIFICATE
PRINT NAME CLEARLY & EXACTLY AS IS TO APPEAR ON THE DIPLOMA
NAME: ________________________________________________________________________________________________________
FIRST NAME MIDDLE NAME
LAST NAME
Student No. __________________________ Phone No. _________________________________________
Diploma was Earned: Term: Spring
Summer Fall (Mark one) Year: ___________
_____Associate Arts Degree _____ Certificate of Achievement
Major Field of Study: ____________________________________________________________________
Please mail request to: Cerritos College
Admissions & Records
Attn: Graduation Unit
11110 Alondra Blvd.
Norwalk, Ca 90650-6298
________I will Pick-up
my Diploma
Please bring a photo I.D.
Date Picked Up _______ /_______/_______
_______ Please mail
my Diploma to...
Will be mailed to the address indicated above.
Current Address: _________________________________________________________________________________
Address Street/ / Apt.# City, Sate Zip Code
Payment Received: $ ____________________
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RE-ORDER DIPLOMA-FULL PAGE

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Completed 5 April 2020

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