DUPLICATE DEGREE/CERTIFICATE REQUEST
revised: 3/19/18
There is a $10 fee for each duplicate degree/certificate. You should allow 6-8 weeks for
processing and mailing of your request. Payment is due with order. Orders without
payment will not be processed.
Last Name (as appeared on original diploma) First MI
RCC Student ID
Previous/maiden name(s)
Name of program completed
Program completion date
Daytime Phone Email Address
Please mail my duplicate degree/certificate to:
Name
Mailing address
City State Zip
Signature of person who earned the degree/certificate is required
PAYMENT INFORMATION:
_______Total Duplicates Requested $ Total
Make checks payable to: Rogue Community College. Orders without payment will not be processed.
Cash (Do not mail cash) Check Credit Card: Visa MC Discover AMEX
Card Number_______________________________ Expiration date _______ CVV Code (3 digit code on back)______
Cardholder’s Name Cardholder’s Phone
Cardholder’s Signature
E-mail, fax, mail, or
hand-deliver completed
signed form with fee to:
rcs@roguecc.edu
Fax (541) 245-7648 Rogue
Central
Rogue Community College
117 S. Central Ave
G Building
Medford, OR 97501
R
CC is an open institution and does not discriminate. For RCC's non-discrimination policy and a full list of regulatory specific contact
persons visit the following webpage: www.roguecc.edu/nondiscrimination.
