ICHS Duplicate Diploma Request Form | Immaculate Conception High School

Duplicate Diplomas will be mailed to your address once received by the school.

Payment processing is done securely through Square.

Single Duplicate Diploma

Price: $ 60.00

Current Contact Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone # *

Identity Information

Name while in attendance at ICHS *

First

Last

Year of Graduation *

Date of Birth *

Please upload a photo of an ID or identity document showing your Name and Date of Birth (School ID, Drivers License, etc.) *

Click or drag a file to this area to upload.

Diploma Information

Duplicate diplomas will be signed by the current administration

Name Requested on Diploma *

Authorization to Process Diploma

You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this release form and therefore you authorize the release of a new duplicate diploma (school records) concerning the student name provided on this form to be sent to you personally.

Signature *

Payment Information

Credit Card Information *

Card

Name on Card

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Total

$ 0.00