Diploma Request

Complete this form to request copy of your diploma/certificate.

Name*
First Last
Maiden Name
Please list name used while enrolled at the International Institute of Cosmetology, if different than above.
Address*
Street Address Address Line 2 City State ZIP Code

Address where we should mail diploma/certificate to:
Phone*
Date of Birth*
To verify identity
MM slash DD slash YYYY
Program*
Select the program completed at IIC.
Consent*
I certify that I am the above named individual requesting my own diploma/certificate. I understand that International Institute of Cosmetology is not responsible for incorrectly filled request form and if another form needs to be submitted that I will incur the processing/shipping fee again.
I agree to the above and certify that all information entered is true and accurate.
Signature*
Processing Fee:*
Processing fee includes mailing cost.
Credit Card