Alvin Community College
Replacement Diploma
MUST BE PRINTED IN INK:
SSN___________________________ Student ID________________________
Student Name_______________________________________________________________________
__
First MI Last
Print name as it appeared on original degree or certificate:
______________________________________________________________________________
First name Middle name Last name
If you are a current student, we will mail the replacement diploma to the address on file. If you’re not
currently enrolled, indicate where you want your replacement diploma mailed to below.
Address: ____________________________________
City/St/Zip:___________________________________
Phone: _____________________________________
Degree previously received - Check all that apply and write the specific major in appropriate space(s)
below:
[ ] Associate of Arts Degree in: _________________________________________Month/Year_________
[ ] Associate of Arts in Teaching Degree in: _______________________________Month/Year_________
[ ] Associate of Science Degree in: ______________________________________Month/Year_________
[ ] Associate of Applied Science in: ______________________________________Month/Year_________
[ ] Certificate in: _____________________________________________________Month/Year_________
[ ] Certificate in: _____________________________________________________Month/Year_________
Replacement Diploma Fee: $45.00 for each separate diploma
Check enclosed; check must depict street address (not P.O. Box) and driver’s license number.
Write your student ID in the memo line.
Money order enclosed. Write your student ID in the memo line.
You may also call the Business Office Cashier at 281-756-3593 to pay via credit card.
________________________________________ __________________________
Applicant’s Signature Date
Alvin Community College
Registrar’s Office – Graduation Specialist
3110 Mustang Rd.
Alvin, TX 77511
Rev.06/2014
Business Office Use Only
Amount paid _____________ Date ____________
Receipt #_______________ Cashier __________
