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APPLICATION FOR REPLACEMENT OF DIPLOMA:

1. Student Name: ___________________________________________________

2. Date: ________________ E-mail: ____________________

3. Please Read: This form must be sent by Express Registered Mail. You must include the $150 CDN Replacement Fee, required to finalise the replacement process, and re-printing fee. Please initial: ______________

4. Name as You Would Like it Professionally Printed: ___________________________________________________

5. Please Note: Check Above Spelling and Credentials.

6. Address to Which Diploma will be Sent: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

7. For Credit Card Payments Please Print your information here:

Credit Card Type: ___________________________________
Credit Card Number: _________________________________
Exact Name on CC: __________________________________

Three or Four Digit Pin On Back of Card: ________________
Signature: __________________________________________
Date: ______________________________________________

You may also phone in your Credit Card Information to us!!
1 403 347 9019, 1 888 686 6163, or 1 403 454 2887.

Student Services Officer Signature: ___________________________________________________

Presidents Signature and Date: ___________________________________________________
8. Date Sent: _______________________________________

9. Student Services Officer Signature: ___________________________________________________

END OF APPLICATION FOR REPLACEMENT DIPLOMA FORM.