Replacement Diploma Request Form
ALUMNI PAYMENT must be received prior to ordering the Diploma. Each Replacement Diploma is $15 and may be paid online through the YHS Webstore. Please note that it takes anywhere from 6 - 8 weeks to process as the Company prints a new one.

Webstore: https://webstores.activenetwork.com/school-software/yucaipa_high_schoqq6/index.php?l=product_detail&p=335#.Wlkhp66nFhE

Email address *
Last Name: (in school) *
First Name: *
Middle Initial
Email *
Current Phone Number: *
Date of Birth *
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Year of Graduation: *
Current address: *
City *
State *
Zip: (postal code) *
Please upload a copy of your ID (driver's license or other government/state/educational ID) *
Required
Authorization Notification: My initials below constitute an electronic signature and authorizes the Records Department of The Yucaipa-Calimesa Joint Unified School District to release information and/or my student record(s) and confirms I have completed all sections accurately and truthfully, including information verifying my identity. I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therin shall not be further transferred or communicated to any other part or agency without my expressed written consent except under authority of Public Law 93-380, Educational Rights and Privacy Act.
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Electronic Signature *
A copy of your responses will be emailed to the address you provided.
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