Replacement Diploma Request – Breining Institute

Instructions

Ordering Process

Replacement Diploma

If an original diploma is lost or destroyed, it may be replaced. A diploma may be re-issued with a new legal name.

After receipt of a replacement request, the new diploma will typically be mailed within three to six weeks from receipt of the Replacement Diploma Request form and $75 processing fee payment for each diploma ordered.

New Legal Name

To request that a replacement diploma be re-issued in a new legal name, and to change that name on Breining Institute records, submit a Legal Name Change or Correction form in addition to the replacement request. Evidence of a court order changing the legal name is required.

Processing

Replacement Diplomas are processed once per month, typically mid-month. Thus, it will typically take from 3 to 6 weeks before we have completed our archive search, created a new diploma, and submitted it to the U.S. Post Office (or other carrier) for delivery to you.

Please allow two months for delivery of replacement diploma.

PLEASE NOTE: The Office of the Registrar takes responsibility for handling replacement diploma requests in a prompt and efficient manner. However, we are not responsible for mishandling by the U.S. Post Office or other shipping agencies.

Credential Holder Info

Student Information

Full Diploma Name: *

Other names (if applicable) under which the diploma(s) may have been issued:

Last four digits of your Social Security Number *

Date of Birth *

Email Address: *

Confirm Email Address: *

Primary Phone Number *

Diploma Info

Duplicate Diploma(s) Requested

Breining Institute Diploma Earned *

Please select the Breining Institute diploma for which you are ordering a replacement.

Addiction Studies Certificate (ASC) Program - 45 units

Associate of Arts in Addictive Disorders Degree Program

Bachelor of Arts in Addictive Disorders Degree Program

Master of Arts in Addictive Disorders Degree Program

Doctor in Addictive Disorders (Dr.AD) Degree Program

Special Instructions (if any)

Please advise if there are special instructions, such as requesting more than one copy of a certain diploma, or shipping to an address outside of the United States.

Shipping of the replacement diploma to addresses within the United States is included, at no extra cost. There will be additional charges for shipping to addresses outside of the U.S., which will be charged to the credit card if you give us authorization to do so here.

Address and Payment Info

Address Information

Where do you want the diploma(s) sent?

We will send the requested diploma(s) to the mailing address you identify within this section. We will send them by regular First Class mail, using the U.S. Postal Service (USPS). If you desire tracking service, you may select the USPS Priority Mail or the UPS Ground Shipping option when completing the Payment Information, below.

Name *

Street address (include Apt or Suite number, if applicable) *

City: *

State / Province: *

ZIP Code or Country Code:

Country:

Country (if not the United States):

Payment Information

Order *

Select the number of diploma(s) you are ordering:

$75: I am ordering ONE (1) diploma to be sent via regular First Class USPS mail to the person and address identified above.

I am ordering more than one diploma to be sent via regular First Class USPS mail to the person and address identified above. I authorize a charge to my credit card of $75 for each diploma ordered.

Optional Shipping Tracking:

$35: Add this charge to send my diploma(s) via UPS Ground Shipping to the person and address identified above. This option may NOT be selected if the shipping address is a P.O. Box.

$40: Add this charge to send my diploma(s) via USPS Priority Mail to the person and address identified above.

You give permission to and authorize Breining Institute is authorized to charge the total amount of the item(s) selected, above, to the following credit card:

Credit Card: *

VISA

MasterCard

Discover

Credit Card Number: *

Credit Card Expiration Date *

Full Name on Credit Card: *

Are you ready to submit your request?

PLEASE NOTE: Replacement diplomas are processed once per month, typically mid-month. Thus, it will typically take from 3 to 6 weeks before we have completed our archive search, created a replacement diploma, and submitted it to the U.S. Post Office (or other carrier) for delivery to you.

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