{"id":1590,"date":"2023-09-12T18:23:01","date_gmt":"2023-09-12T18:23:01","guid":{"rendered":"https:\/\/ct-prod-wp.taftcollege.edu\/forms\/?page_id=1590"},"modified":"2023-09-12T21:53:58","modified_gmt":"2023-09-12T21:53:58","slug":"diploma-or-certificate-reissue-form","status":"publish","type":"page","link":"https:\/\/ct-prod-wp.taftcollege.edu\/forms\/admissions\/diploma-or-certificate-reissue-form\/","title":{"rendered":"Diploma or Certificate Reissue Form"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column]<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Diploma or Certificate Reissue Form<\/h2>\n                            <p class='gform_description'>A reissue of a Taft College diploma or certificate costs $15.00 each. The fee includes postage and handling. Once the form has been submitted, you can arrange payment by contacting the Cashier Office at 661-763-7713. \r\n\r\nIf you have multiple reissues, please fill out each one on a separate submission. \r\n\r\nWe are not able to reissue WESTEC certificates. To request a WESTEC certificate, please contact 661-387-1055.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_75'  action='\/forms\/wp-json\/wp\/v2\/pages\/1590' data-formid='75' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LdUtCUoAAAAAK8BHm9bjuYo2AyRrM5wkTXmVBww' data-tabindex='0'><input id=\"input_a787bb32a3d5ff316f06c65d499151a3\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_a787bb32a3d5ff316f06c65d499151a3\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_75' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_75_4\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Student Information<\/h3><\/div><fieldset id=\"field_75_1\" class=\"gfield gfield--type-name gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name has_suffix gf_name_has_4 ginput_container_name gform-grid-row' id='input_75_1'>\n                            \n                            <span id='input_75_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_75_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_75_1_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            <span id='input_75_1_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_75_1_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                    <input type='text' name='input_1.4' id='input_75_1_4' value=''   aria-required='false'     \/>\n                                                <\/span>\n                            <span id='input_75_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_75_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_75_1_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            <span id='input_75_1_8_container' class='name_suffix  gform-grid-col gform-grid-col--size-auto' >\n                                                        <label for='input_75_1_8' class='gform-field-label gform-field-label--type-sub '>Student ID<\/label>\n                                                        <input type='text' name='input_1.8' id='input_75_1_8' value=''   aria-required='false'   placeholder='A000000000'  \/>\n                                                    <\/span>\n                        <\/div><\/fieldset><div id=\"field_75_3\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-third center-date gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_75_3'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_75_3'>Enter your Birth date.<\/div><div class='ginput_container ginput_container_date'>\n                            <input name='input_3' id='input_75_3' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_75_3_date_format gfield_description_75_3\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_75_3_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_75_3' class='gform_hidden' value='https:\/\/ct-prod-wp.taftcollege.edu\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_75_34\" class=\"gfield gfield--type-email gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Student Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_75_34_container'>\n                                <span id='input_75_34_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_75_34' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                    <input class='' type='email' name='input_34' id='input_75_34' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                <\/span>\n                                <span id='input_75_34_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_75_34_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                    <input class='' type='email' name='input_34_2' id='input_75_34_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_75_5\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Degree\/Certificate Information<\/h3><\/div><fieldset id=\"field_75_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is this request for a degree or certificate?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_75_16'>\n\t\t\t<div class='gchoice gchoice_75_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Degree'  id='choice_75_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_75_16_0' id='label_75_16_0' class='gform-field-label gform-field-label--type-inline'>Degree<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_75_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Certificate'  id='choice_75_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_75_16_1' id='label_75_16_1' class='gform-field-label gform-field-label--type-inline'>Certificate<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_75_6\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What semester did you graduate?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_75_6'>\n\t\t\t<div class='gchoice gchoice_75_6_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Fall'  id='choice_75_6_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_75_6_0' id='label_75_6_0' class='gform-field-label gform-field-label--type-inline'>Fall<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_75_6_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Spring'  id='choice_75_6_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_75_6_1' id='label_75_6_1' class='gform-field-label gform-field-label--type-inline'>Spring<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_75_6_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_6' type='radio' value='Summer'  id='choice_75_6_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_75_6_2' id='label_75_6_2' class='gform-field-label gform-field-label--type-inline'>Summer<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_75_26\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_75_26'>What year did you graduate?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_75_26' type='text' value='' class='large' maxlength='4'    aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_75_12\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_75_12'>Degree Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_75_12' type='text' value='' class='large'  aria-describedby=\"gfield_description_75_12\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_75_12'>Please list the name of the degree you are requesting to be reissued. If you are unsure, please contact our office at 661-763-7741.<\/div><\/div><div id=\"field_75_27\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_75_27'>Certificate Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_75_27' type='text' value='' class='large'  aria-describedby=\"gfield_description_75_27\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_75_27'>Please list the name of the certificate you are requesting to be reissued. If you are unsure, please contact our office at 661-763-7741.<\/div><\/div><fieldset id=\"field_75_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Method of Delivery<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_75_18'>\n\t\t\t<div class='gchoice gchoice_75_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Pick-Up'  id='choice_75_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_75_18_0' id='label_75_18_0' class='gform-field-label gform-field-label--type-inline'>Pick-Up<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_75_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Mail'  id='choice_75_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_75_18_1' id='label_75_18_1' class='gform-field-label gform-field-label--type-inline'>Mail<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_75_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Who will be picking up the order?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_75_31'>\n\t\t\t<div class='gchoice gchoice_75_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='I will pick-up the order'  id='choice_75_31_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_75_31_0' id='label_75_31_0' class='gform-field-label gform-field-label--type-inline'>I will pick-up the order<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_75_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='I will be delegating someone else to pick up the order'  id='choice_75_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_75_31_1' id='label_75_31_1' class='gform-field-label gform-field-label--type-inline'>I will be delegating someone else to pick up the order<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_75_32\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_75_32'>Name of Delegated Person<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_75_32' type='text' value='' class='large'  aria-describedby=\"gfield_description_75_32\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_75_32'>Individual must present a photo ID and name on ID must match what you enter in this field.<\/div><\/div><fieldset id=\"field_75_22\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_75_22' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_75_22_1_container' >\n                                        <label for='input_75_22_1' id='input_75_22_1_label' class='gform-field-label gform-field-label--type-sub '>Name<\/label>\n                                        <input type='text' name='input_22.1' id='input_75_22_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_75_22_2_container' >\n                                        <label for='input_75_22_2' id='input_75_22_2_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_22.2' id='input_75_22_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_75_22_3_container' >\n                                    <label for='input_75_22_3' id='input_75_22_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_22.3' id='input_75_22_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_75_22_4_container' >\n                                        <label for='input_75_22_4' id='input_75_22_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                        <select name='input_22.4' id='input_75_22_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' selected='selected'>California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_75_22_5_container' >\n                                    <label for='input_75_22_5' id='input_75_22_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                    <input type='text' name='input_22.5' id='input_75_22_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_22.6' id='input_75_22_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_75_25\" class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Student Verification<\/h3><\/div><fieldset id=\"field_75_28\" class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Payment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_28.1' id='input_75_28_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_75_28_1' >I understand that my order will not be processed until I have completed my $15.00 payment with the Cashier Office.<\/label><input type='hidden' name='input_28.2' value='I understand that my order will not be processed until I have completed my $15.00 payment with the Cashier Office.' class='gform_hidden' \/><input type='hidden' name='input_28.3' value='12' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_75_29\" class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Processing<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_29.1' id='input_75_29_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_75_29_1' >I understand that my order will be processed within 5 business days of payment date.<\/label><input type='hidden' name='input_29.2' value='I understand that my order will be processed within 5 business days of payment date.' class='gform_hidden' \/><input type='hidden' name='input_29.3' value='12' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_75_33\" class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Release of Records<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_33.1' id='input_75_33_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_75_33_1' >I agree to release my reissued diploma or certificate to the delegated person above.<\/label><input type='hidden' name='input_33.2' value='I agree to release my reissued diploma or certificate to the delegated person above.' class='gform_hidden' \/><input type='hidden' name='input_33.3' value='12' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_75_23\" class=\"gfield gfield--type-signature gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_75_23'>Student Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_23' id='input_75_23_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_75_23_Container' class='gfield_signature_container ginput_container' style='height:180px; width:300px; ' ><canvas id='input_75_23' width='300' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/ct-prod-wp.taftcollege.edu\/forms\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_75_23_toolbar' style='margin:5px 0;position:relative;height:20px;width:300px;max-width:100%;'><img id = 'input_75_23_resetbutton' src='data:image\/png;base64,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' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_75_23_data' name='input_75_23_data' value=''><\/div><\/div><fieldset id=\"field_75_30\" class=\"gfield gfield--type-date gfield--input-type-datefield gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_75_30' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_75_30_1_container'>\n                                            <label for='input_75_30_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                                            <input type='number' maxlength='2' name='input_30[]' id='input_75_30_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                        <\/div><div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_75_30_2_container'>\n                                            <label for='input_75_30_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                            <input type='number' maxlength='2' name='input_30[]' id='input_75_30_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_75_30_3_container'>\n                                            <label for='input_75_30_3' 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