Submit this form, along with your check or money order, in person or by mail to:
Bursar / Student Accounts DIF 120
Student & Administrative Services Center, Room 2098
Pennsylvania College of Technology
One College Avenue
Williamsport, PA 17701-5799
The fee is $15 for a reissued diploma. Make check or money order payable to Pennsylvania College of Technology.
The requested diploma will be mailed by the Registrar’s Offi ce approximately one week after receipt of the request.
Student name ____________________________________________________________________________________
Former name _____________________________________________________________________________________
Penn College student ID or Social Security* number ________________________________________________
Date of graduation ________________________________________________________________________________
Month Year
Major ____________________________________________________________________________________________
Degree received __________________________________________________________________________________
Phone (daytime) ( _______ ) _________________________
Address where diploma is to be mailed:
Name ____________________________________________________________________________________________
Address __________________________________________________________________________________________
Street/Box number/Apartment
__________________________________________________________________________________________
City State ZIP code
Student signature __________________________________________ Date _________________________________
*
The Registrar’s Offi ce requires your Penn College ID or Social Security number for the purpose of verifying your identity with offi cial educational records. The College
will not disclose Social Security numbers to anyone outside of the College without an individual’s consent except as mandated by law.
Reissue Diploma Request
For all graduates of Williamsport Technical Institute,
Williamsport Area Community College,
and Pennsylvania College of Technology.
PC1227 4/19
