IDENTIFICATION: Please list the Student ID Number issued while in attendance at CSULA.

CIN SID or last 4 digits of your SSN PFN

If you have recently filed for a name change, please check: [ ]

FIRST NAME MIDDLE NAME LAST NAME

DEGREE INFORMATION:

DEGREE DATE:

DEGREE:

MAJOR:

OPTION:

MAILING / CONTACT INFORMATION: Your diploma will be sent to the diploma mailing address listed on your GET account unless you indicate a different address below:

STREET ADDRESS

CITY STATE POSTAL

PHONE EMAIL - (Optional) to receive status notifications.

Please indicate your delivery preference: [ ] MAIL - Your diploma/certificate(s) will be mailed.[ ] PICK UP - You will be contacted for pick up.

(Optional) Reason for requesting duplicate: (I.E.: name change, original not received, damaged in mail, framing purposes, submitting original payment, etc.)

CSULA Graduation Office5151 State University DriveLos Angeles, CA 90032-8531

Please allow 4-6 weeks for distribution.

There is a $10 fee for each duplicate diploma/certificate. Please submit 1 form per degree sought along with the check or money orderpayment, payable to Cal State L.A. All checks and money orders must be drawn from an American bank account.

DUPLICATE DIPLOMA / CERTIFICATE REQUESTComplete this form to order a duplicate copy of a diploma or a duplicate copy of a certificate. For every duplicate degree sought, submita copy of this form with a $10 check or money order payable to Cal State L.A., to the Enrollment Services Office - ADMIN 146 or by mail:

CSULA Graduation Office, 5151 State University Drive | Los Angeles, CA 90032-8531.

The name on your duplicate diploma/certificate will appear exactly as your CSULA records. If your name has changed since the issuanceof your original diploma/certificate, please submit the Bio/Demo Change form available in Student Affairs, Room 101 prior to submittingthis form. Please print clearly and be sure to indicate below if you have any accent marks, hyphenations, or abbreviations in your name.

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BA BM BS BE MA MBA MM MFA MS MSW Doctorate Certificate