DIPLOMA REQUEST FORM
Name:_______________________________ Student Number: __________________
Term and Year Graduated: _______________________________________________
Attendance Dates: ______________________________________________________
Phone: ___________________________ Email: ______________________________
If you had more than one degree or certificate, indicate which one or both that you want
reprinted: _____________________________________________________________
Mailing Address: (Diploma will be mailed)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
*Diplomas are printed only at the request of the student. All financial obligations to GSCC must be
fulfilled before any diploma can be printed. The diploma fee of $10 for each degree or certificate has to
be received prior to printing.
To make the payment online, login to Self Service Banner, then under Student Tab, click Student
Account, then click Account Detail for Term. Select the latest term, then click Pay Now. Once payment is
made, please mail or e-mail this request along with proof of payment to the Records office. ***Allow 2-
3 weeks for processing.
E-mail - records@gadsdenstate.edu
Gadsden State Community College
P. O. Box 227
Gadsden, AL 35902
Phone: 256-549-8261
Signature: _______________________________________ Date: ___________________
FOR OFFICE USE ONLY
Graduation Date: ________________________________ Date Mailed: _____________
(Rev 11/18)
