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: ________________
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
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.)
City State Zip Code
DEGREE/CERTIFICATE EARNED _______________________________________________
(Please indicate exact program title.)
MONTH AND YEAR OF DEGREE (approximate) _____________________________________
Student Signature _____________________________________________________________
Business Office Validation: Payment received_______________ Date________________