Admissions Copy
University of Hawai’i – Leeward Community College
Request for Duplicate Diploma/Certificate
I certify that the information provided herein is true and correct.
*********************************************OFFICE USE ONLY**********************************************
REV: 01/2015
Name:
Mail Diploma to:
Last First M.I.
Street Address
Student ID No.:
City State Zip
Phone:
Home
Work/Cell
E-mail:
Clearly print your LEGAL name exactly as you would like it to appear on your diploma, including punctuations and diacritical markings.
First
Middle
Last
Semester and year awarded:
Fall 20
Spring 20
Summer 20
Degree (check one):
Major:
A.A. Degree (specify)
A.A.S. Degree (specify)
A.S. Degree (specify)
Certificate of Achievement (specify)
Certificate of Completion (specify)
Academic Subject Certificate (specify)
Certificate of Competence (specify)
I would like to reorder my diploma(s) in the following language:
English ($15 each)
Total:
Hawaiian ($15 each)
Student’s Signature:
Date:
Amount Paid: $
Date Paid:
Received by:
Clear Form
Student’s Copy
University of Hawai’i – Leeward Community College
Request for Duplicate Diploma/Certificate
I certify that the information provided herein is true and correct.
*********************************************OFFICE USE ONLY**********************************************
REV: 01/2015
Name:
Mail Diploma to:
Last First M.I.
Street Address
Student ID No.:
City State Zip
Phone:
Home
Work/Cell
E-mail:
Clearly print your LEGAL name exactly as you would like it to appear on your diploma, including punctuations and diacritical markings.
First
Middle
Last
Semester and year awarded:
Fall 20
Spring 20
Summer 20
Degree (check one):
Major:
A.A. Degree (specify)
A.A.S. Degree (specify)
A.S. Degree (specify)
Certificate of Achievement (specify)
Certificate of Completion (specify)
Academic Subject Certificate (specify)
Certificate of Competence (specify)
I would like to reorder my diploma(s) in the following language:
English ($15 each)
Total:
Hawaiian ($15 each)
Student’s Signature:
Date:
Amount Paid: $
Date Paid:
Received by:
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