366 Luna Drive Las Vegas, NM 87701
(505) 454-2548 (800) 588-7232 FAX (505) 454-5348
Office Use Only:
Amount Paid:_____________ Date : ____________
Signature of Fiscal Office: ______________________
Processed by: _____________________
Date Mailed: _______________________ 10/13/17-HM
BOT Approved 10/10/17
Replacement/Duplicate Diploma
Request Form
A replacement or duplicate diploma is printed in the current format showing the graduate’s name, degree/certificate
earned, designated honors, and date of graduation. All signatures on the diploma will be those of incumbent college
officials at the time of request. Allow 2 3 weeks for processing.
A fee of $10.00 is charged for a replacement/duplicate diploma (fee is subject to change)
Mark for Rush Processing add $25.00 (24 hour processing)
Mark for Certified Mail add $7.00 (standard processing)
Complete this form and submit with payment to the LCC Fiscal Office. Once fee is paid Fiscal Office must
provide proof of payment by designation below. Once completed and paid for return this form to the LCC
Office of the Registrar. If this form is being submitted by mail, complete the form and attach money order
for $10.00 made payable to LCC and mail to address above (personal checks are not acceptable). Payment
may also be made by phone with the LCC Fiscal Office by calling 505-454-2506.
Name at the time of graduation:
Name you wish to have printed on your diploma/certificate:
(If the above name is different than that printed below, legal documentation must accompany this request)
LCC Student ID#:
Diploma Mailing Information:
Mailing Address
City State Zip Code
Telephone Number (include area code) Email Address
This form can only be submitted by the student in accordance with the Family Educational Rights and
Privacy Act of 1974.
_____________________________________ _______________________
Graduates Signature Date
Associate Degree