KM 05/2020
THE COLLEGE OF THE FLORIDA KEYS
APPLICATION FOR REPLACEMENT DIPLOMA
There is a $25.00 charge for replacement diplomas.
For assistance completing this form contact Enrollment Services at 305-809-3188.
Date of Request: ________________
MM/DD/YY
Select your payment option:
_____ USPS mail this completed form along with a check or money order to:
CFK Admissions, 5901 College Road, Key West, FL 33040
_____ Fax to 305-262-5163. You may also scan or cell-phone photo this form then email to
admissions@fkcc.edu
Call the Business Office at 305-809-3186 to pay via credit or debit card.
NAME (Please print your name EXACTLY as you want it to appear on your diploma).
First Middle Last
______________________ ______________________
Student ID Number or Date of Birth MM/DD/YY
Last 4 digits of your SS#
ADDRESS (Your diploma will be mailed approximately 1 month after receipt of payment.)
Street
City State Zip Code
________________________
Telephone
DEGREE/CERTIFICATE EARNED _______________________________________________
(Please indicate exact program title.)
MONTH AND YEAR OF DEGREE (approximate) _____________________________________
Student Signature _____________________________________________________________
Business Office Validation: Payment received_______________ Date________________
