Thomas Edison State University     

 

 

Replacement/Duplicate NJ State Librarian Certificate Request Form

Please use this form to request a replacement/duplicate NJ State Librarian Certificate. You must have already been issued a NJ Librarian Certificate from TESU in order to request a replacement or duplicate certificate. 

* Required Fields

Current Name
First*: Middle: Last*: Suffix:
Name on initial certificate (if different from above)
First:   Middle: Last:  Suffix:

University ID or Last 4 of SSN*:		 Re-enter University ID or Last 4 of SSN*:


Date of Birth*:
   
Current Address*:
City*:
State*:

Zip Code*:
Country*:
   
Phone Number*:
E-mail Address*:
 
I authorize Thomas Edison State University to send my replacement certificate to the address listed below. If no address is provided below, the replacement certificate will be mailed to the current address provided on this form.
   
Recipient Name:
Address:
City:
State:
Zip Code:
Country:
 

Fee Amount:  
$40.00 (Nonrefundable)


PLEASE READ and agree to the following terms and conditions:*

Credit and debit card payments are handled through a third party payment processor. A non-refundable convenience fee of 2.95 percent (with a minimum charge of $3.00) will be added to your total charges for this processor. The University does not receive any portion of convenience fee payments.

To avoid convenience fees you can pay via electronic check/ACH payment. Electronic check/ACH payments require your bank routing and account numbers. The routing number and checking account number can be found on the bottom of your personal check.

I have read and agree to the above terms and conditions.

Method of Payment:

Credit/Debit Card Electronic Check (ACH)

When paying by credit card or electronic check, you will be prompted for credit card/check information upon submitting this form.

Please note that payment must be confirmed for transaction to be completed.