General Information:
Replacement diplomas are available to students for a charge of $10 per copy. Please remit payment with this
form. Once payment is secured, this request will be forwarded to the Graduation Specialist for processing.
Note: This request may take up to 6 weeks for processing.
Instructions:
1. Fill out this form completely.
2. Fax or mail form to Admissions Office at 4015 Avenue Q, Galveston, TX 77550 or 409-944-1501.
3. Mail payment ($10 per diploma copy) with form or call the Business Office at 409-944-1362 to pay
with credit card by phone.
4. Students may contact the Office of Admissions at 409-944-1230 for the status of the replacement
diploma request.
Please Complete the Following Information:
Term of Graduation: Fall Spring Summer I Summer II Year: _________
Student Name: _____________________________ Student ID or SS #:
Name for Diploma: ________________________________________________________________
First Name Middle Name Last Name
Mailing Address:_______________________________________________________________
Street/P.O. Box # City State Zip Code
Contact Telephone: __________________ Email Address: ______________________________
Degree/Certificate (circle): AA AAS AS AAT Certificate
Program of Study: ___________________________________________________________
Student Signature: __________________________________ Date: ________________________
(For Office Use Only)
Graduation Date: ____________________ Staff Verification Initials: ______________ Diploma Mailed: __________________
Notes:__________________________________________________________________________________________________________
Galveston College is an Equal Opportunity/Affirmative Action Institution
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