Replacement Diploma or Certificate

This form is for any PAST OJC STUDENT who needs to order a replacement diploma or certificate.

NOTE: Any CURRENT STUDENT needing a diploma MUST fill out a full graduation application.


Print full legal name as you want it to appear on your diploma or certificate
First Name:		*Required Field
Middle Name (or initial):		*Required Field
Last Name:		*Required Field
Your Student S #: (N/A if you don't have one)		*Required Field
If you didn't have a S# or don't remember your S# and entered N/A above please fill out the following information: Date of Birth: Last Four Digits of SSN: Dates you attended OJC:
Email:		*Required Field

Permanent Mailing Address:
Address:		*Required Fields
City: State: Zip Code:
Current Phone:		*Required Field
DEGREE/CERTIFICATE: (If Unsure contact Student Services at 384-6831)	Associate of Arts TRANSFER Associate of Science TRANSFER Associate of General Studies NON-TRANSFER Associate of Applied Science NON-TRANSFER Certificate NON-TRANSFER *Required Field
** NOTE: If you choose Associate of Applied Science or Certificate please enter your emphasis.
Emphasis:
All diplomas are a $20 charge and will be billed to your account when your diploma is ordered.
If you have any questions about this form please contact Student Affairs at 719-384-6831.