Kankakee Community College
Diploma/Certificate Replacement Request
100 College Drive • Kankakee, IL 60901-6505 • 815-802-8520 • FAX: 815-802-8521
Diploma replacement fee: $25. Certificate replacement fee: $3.
Your diploma/certificate will be ordered upon receipt of the completed request form and full payment. It will be mailed or avail-
able for pickup in four to six weeks. Any outstanding financial obligations to KCC must be paid in full before this request will be
processed.
PLEASE PRINT. FILL IN ALL INFORMATION.
Social Security number or Student ID no.:
Name:
Address:
City: State: ZIP code:
Phone: Phone (alternative):
Degree/certificate name: Year:
Check one: ❏ Receive diploma/certificate by mail in four to six weeks ❏ Pick up diploma/certificate in four to six weeks
Applicant’s signature Date
OFFICE USE ONLY
Obligations: ❏ Cleared Date: / / By:
$3 certificate fee: ❏ Paid Date: / / By: Receipt no.:
$25 diploma fee: ❏ Paid Date: / / By: Receipt no.:
Status: ❏ Mailed ❏ Picked-up Date: / / By:
Method of payment: ❏ Cash ❏ Check/money order (payable to: Kankakee Community College)
❏ Credit card (Visa / MasterCard / Discover)
Name on card (if different):
Account number: - - -
Expiration date: / / 3 digit security code (on back of credit card):
REV. 06/2013
Complete form online, print and mail with your check or with credit/debit card information to:
Kankakee Community College • Admissions & Registration • 100 College Drive • Kankakee, IL 60901-6505
