Fillable REPLACEMENT DIPLOMA REQUEST (Rockingham Community College)

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REPLACEMENT DIPLOMA REQUEST (Rockingham Community College)

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File type: PDF

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___________________________________________________________________
__________________________
___________________________________________________________________
__________________________
Records Office
PO Box 38 Wentworth NC 27375
336.342.4261 Phone
336.342.1809 Fax
REPLACEMENT DIPLOMA REQUEST
STEP 1: Submit completed form to Records Office (located in the Whitcomb Student Center).
STEP 2: Pay the $35 fee to Business Office
(located in the Administration Building).
STUDENT ID# ____ ____ ____ ____ ____ ____ ____
PHONE: ________________________________________
OR
LAST FOUR DIGITS OF SSN: ____ ____ ____ ____
NAME: ____________________________________________________________________________________________
FORMER NAME
(if has changed): ________________________________________________________________________
MAILING ADDRESS: _________________________________________________________________________________
CITY: ___________________________________________________ STATE: ____________ ZIP: __________________
PROGRAM OF STUDY:
GRADUATION DATE:
Degree
Diploma
Certificate
NUMBER REQUESTED: _______________________________ ($35 fee per diploma applies)
The $35 fee (per diploma) must be paid at the time the request is submitted. Orders may take 8-12 weeks for delivery. Replacement diplomas are
issued with “Issued as a replacement diploma” text and are signed by current administration. Graduate will be contacted via telephone at the number
provided when the diploma is available.
Student signature
Date
Unless sent from an official Rockingham Community College email account, this form must have a handwritten signature.
RECEIVED:
Student signature
Date
OFFICE USE ONLY
RECORDS _______________________
Initials/date
FEE PAID
Receipt #
WEBSITE COPY - 1 additional copy for Student 8/2016
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REPLACEMENT DIPLOMA REQUEST (Rockingham Community College)

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Completed 26 July 2020

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