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.
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
City _____________________________________________ State _______________ Zip Code _________________
Home Phone: ____________________________________ Cell Phone: ___________________________________
**You must sign the form before your request will be processed.**
Student Signature
Registrar’s Office Use Only
Graduation Verified
Clearance Verified
Program Completed: _______________________ Eligible for Reprint: Yes or No
Semester Completed: ______________________ Date Mailed: _____________________________
Date Conferred: ___________________________ Mailed By: _______________________________