Rev. 10/24/18
GUILFORD TECHNICAL COMMUNITY COLLEGE
PO Box 309 • Jamestown, NC 27282 • 336/334-4822 or 336/454-1126 • TTY 336/841-2158
Request for Degree/Diploma/Certificate Reprints
Legal name only. No nicknames, etc. Name must match school records.
First Name
Middle Name
Last Name
Maiden Name (if applicable)
Address: ___________________________________________ City: ____________________________ State: ________
Zip: ________________ GTCC Email: (If Active) ______________________________________________
Personal Email: _________________________________________________ Date of Birth: _________________
Telephone(s): Home: ( ) _________________ Business: ( ) _________________ Cell: ( ) __________________
Please mail the form with payment to the Casher’s Office at
Guilford Technical Community College Attention Cashier’s Office P.O. Box 309 Drawer R Jamestown, NC 27282
( ) Please check the box if you would like your Degree(s), Diploma(s), Certificate(s) mailed to you.
Please indicate the number of (Degree(s), Diploma(s), Certificate(s) you would like to order below in the
Award
box.
I am requesting a reprint for the following earned awards.
Award
Fee
Name of degree(s), diploma(s), certificate(s):
( ) Degree (Two-Year) $10.00
_____________________________________________________
( ) Diploma (One-Year) $10.00 __________________________________________________________
( ) Certificate $5.00 __________________________________________________________
Please indicate what year you graduated: ____________
Student Signature: ___________________________________________ Date: ______________________
Office Use Only:
Program: ____________________________________ Program Code: _______________ Student ID: ___________
Certificate Payment Received (Cashiers Office)
Date:
Amount:
Staff Initials:
Receipt. No.:
Notes:
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signature
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