Request for Replacement Diploma

Name(Required)

First Last

Social Security or KWC ID(Required)

Date of Birth(Required)

Degree Earned(Required)

Major(Required)

Date Degree Earned(Required)

Daytime Phone(Required)

Email(Required)

Name on Diploma(Required)

Diploma Pickup(Required)

I will pick up my diploma in the Office of the Regisrar

Mail my diploma to the address below (Additional charge will be applied for mailing).

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Make checks payable to: Kentucky Wesleyan College Attn: Registrar, 3000 Frederica St. Owensboro, KY 42301. If you wish to pay by credit card, please contact the Cashier’s Office at 270-852-3108.

Enclose $50 for each diploma requested. Enclose $10 for each diploma you are requesting to be mailed to a location in the USA. Enclose $50 for each diploma you are requesting to be mailed outside of the USA.