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 Office 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 Office requires your Penn College ID or Social Security number for the purpose of verifying your identity with official 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.
PC-1227 10/16
Reissue Diploma Request
For all graduates of Williamsport Technical Institute,
Williamsport Area Community College,
and Pennsylvania College of Technology.
