8/17
Willmar Campus
Registration Office
2101 15
th
Ave NW
Willmar, MN 56201
320-222-5971
FAX 320-222-5216
A member of the Minnesota State Colleges
and Universities System
Hutchinson Campus
Registration Office
2 Century Ave SE
Hutchinson, MN 55350
320-222-5971
FAX 320-234-8506
Request for Duplicate Diploma
* Write check or money order payable to
"Ridgewater College".
* A separate request form is required for each
mailing address; missing information will delay
processing.
*Allow approximately 2-3 weeks for receipt of
Diploma.
*If you graduated before 7/1/2012, we are unable
to process your request.
* Mail or fax your request to the appropriate
campus listed above.
* Diplomas will reflect name at time of
enrollment unless official documents are
received indicating a name change such as:
Marriage or divorce decree and picture ID.
*Allow approximately 2-3 weeks for receipt of
Diploma.
Name: SSN or Ridgewater ID:
Name while enrolled (if different from above):
Street Address:
City: State: Zip Code: Phone Number:
Degree Awarded:
Certificate
Diploma
Associate of Applied Science (AAS)
Associate of Science (AS)
Associate of Arts (AA)
Date Awarded:
Term/Year
I give Ridgewater College permission to release my Diploma to the name and address
indicated below:
Student Signature: Date:
***This must be signed before we can release your diploma.***
Please mail diploma to this address:
Name:
Attention:
Street:
City: State: Zip Code:
Office Use:
Updated ISRS:
Date sent:
Sent by:
Method of Payment (must accompany diploma request):
$25.00 Per Diploma
Pick one: Cash Check Enclosed Visa MasterCard Discover
Card Number: Expiration Date: Sec. Code:
Name of Card Holder: Signature:
click to sign
signature
click to edit
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click to sign
signature
click to edit
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