Diploma Request Form
Note: The name below will be printed exactly as it is written. Please ensure it is clearly written and correctly spelled.
D
ate: ___________________________ Student ID or Date of Birth: _______________________
F
ull Legal Name (For Diploma): ___________________________________________________________
D
egree Awarded: ______________________________________________________________________
Term Awarded: ____________________________
D
o you want your diploma mailed to you? Yes No
Note: There will be an $11 mailing fee added to your account in addition to the diploma fee if you select to have the diploma
mailed.
If yes, to what address?
Address Line: _________________________________________________________________________
City: ________________________________ State: _____________ Zip: ____________________
By signing below I acknowledge that a diploma fee of $15 will be applied to my Lamar State College -
Port Arthur account and must be paid before I will receive my diploma. Fees must be paid through the
Business Office either over the phone at (409) 984-6126, in person at 1501 Proctor St., Port Arthur, TX
77641 or online at my.lamarpa.edu -> My Services -> Student -> Student Payment Center.
I also acknowledge that this request and fee only applies towards one diploma and tube, any other
diplomas will require a new request and fee to be paid.
Signature: ____________________________________________________________________________
P.O. Box 310 | 1500 Procter Street | Port Arthur, Texas 77641
409-984-6168
