Certificate Duplicate Request Form

International Development Institute

P.O. BOX 20260 – New York, NY 10001 - Tel: (212) 970-2424 (212) 970-2424

Certificate Duplicate Request
Please complete this form to keep accurate records. Attach a copy if available.

Student Information

Student Name *

Please enter the student's full name.

Date *

Date is required.

Document Type

Please include front and back of your personal document.

Attachment (if available)

Selecting a file will upload it automatically.

Student Email *

Enter a valid email address (e.g., name@example.com).

The school will notify you when the updated diploma/certificate is ready.

Mobile Number *

Valid phone number required.

Address *

Please enter a valid street address.

Country *

City *

City must contain letters only (min 2 characters).

State *

Use 2-letter state code (e.g., NY).

Zip Code *

Use a 5-digit ZIP code.

Program Details

Training Program Name *

Training Program Name is required.

Date Completed *

Please select the completion date.

Student ID# (optional)

Certification # (optional)

Home Care Registry # (optional)

Reason for Duplicate Certificate Request *

Lost certificate Damaged certificate Ruined due to fire, water Deterioration due to age or handling Illegible – faded or blurred text Stolen – taken without authorization

Please select exactly one reason.

Once the information is verified, the school will issue an original duplicate certificate or diploma within 30 days of the request date.

Verification & Signature

Student Signature (type full name) *

Please type your full name. Typing your name is the legal equivalent of your handwritten signature.

By typing your full name, you agree this is the legal equivalent of your handwritten signature.

Date *

Date is required.