Request for Replacement Diploma

*Please note that the cost for a diploma replacement is $10. Upon submission, you will be redirected to a payment screen.

First Name:

Last Name:

PJC Student ID #:

If you do not remember your ID #, please click here.

Date of Graduation:

Degree Received:

(Ex. Associate of Science)

Cell Phone:

E-Mail Address:

Name as you want it printed on the Diploma:

Mailing Address

Street Address:

State:

Zip:

City:

By typing your full name and date, you certify that the above information is correct:

Date: