rev. 7 Aug 2020
The diploma replacement fee is $15 for the diploma or $25 for the diploma replacement plus the diploma cover. Please provide the
information requested on this form and submit it with your payment (make checks payable to Geneva College) to:
Geneva College Registrar’s Office 3200 College Ave Beaver Falls, PA 15010
Name ____________________________________ _______________________ ___ Date ______________
Last First MI
Student ID __________________________ Date of Birth ______________________
Other names you used ______________________________________________________________________
Major(s) _______________________________________________
Degree ________________________________________________
Graduation date _________________________
Daytime Phone __________________________ Email ____________________________________________
Current Home Address __________________________________________________
__________________________________________________ _____ ________
City State ZIP
Print your legal name below as it should appear on your diploma.
__________________________________________________________________________
Signature ________________________________________________
(Required)
click to sign
signature
click to edit
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