Replacement/Duplicate Award Request
Important Information:
• Submit completed form by clicking the submit button.
• Credentials are mailed to the address that is specified on the form.
• Reissued credentials bear the signatures of the current officials in office.
• Credentials will not be printed if you have financial obligations to YTC.
• A separate request form is required for each program of study.
• Please allow 2-3 weeks after the request form has been received for processing and delivery.
Name:
First: _____________________________ Middle: _______________________ Last: __________________________
(List name as it appears on official YTC records)
Please print your name as it should appear on the award.
Print Name (First, Middle, Last, Suffix)
Please Note: A Student Information Update Form must be completed along with legal proof of name change if the award name
differs from the official YTC records.
Basic Information:
Degree: Associate Diploma Certificate
Program Major: __________________________________________________________________________________
Term Awarded: Fall Spring Summer Year: __________________
Date of Birth: ____________________________ YTC Student ID or Last 4 digits of SSN: _______________________
Mailing Information:
Preferred method of delivery (choose one): Mail Pick up in person
Address_________________________________________________________________________________________
City _____________________________________________ State _______________ Zip Code _________________
Home Phone: ____________________________________ Cell Phone: ___________________________________
**You must sign the form before your request will be processed.**
Registrar’s Office Use Only
Program Completed: _______________________ Eligible for Reprint: Yes or No
(circle)
Semester Completed: ______________________ Date Mailed: _____________________________
Date Conferred: ___________________________ Mailed By: _______________________________
