UPDATED: June 13, 2019
Request for Duplicate Diploma
Purpose:
For a student to be able to purchase a duplicate copy of their diploma/certificate. Student must complete form
and submit to business office for payment, then submit form and payment receipt to Registrar for printing.
To be completed by student (print clearly)
Name _____________________________________________ Student ID# ____________________
Date of Birth _______________________ Phone # ________________________
Street Address: _________________________________________________
City : ____________________________ State: _________ Zip Code: _____________
Currently enrolled at RPCC? _______Yes _______ No (if No, answer next question)
Semester/ Year Graduated? _________________
Signature: ____________________________________ Date: ____________________
To be completed by the Business Office
Reprinting Diploma Fee ($20.00)
Paid ___ Rec. #___________________________
CA___ CK___ MO __ #____________________
Business Office Signature: _____________________________________
Date: _________________
To be completed by the Registrar’s Office
Date Diploma Printed: _____________________
Signature of Registrar: ___________________________________
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