Duplicate Credential Request
This form is used to request a duplicate credential (i.e., certificate, diploma, degree). Please complete the information below as accurately as possible. Failure to supply requested information may result in your request being delayed. The credential will be mailed to the address you list below. Please use a separate form for each credential requested.
There is a $20.00 fee per each credential requested.
Make money orders payable to JCTC. Paying with personal check will delay the processing by at least three weeks.
Mail or return this form (along with $20.00 fee) to:
Jefferson Community & Technical College
109 E. Broadway
Louisville, KY 40202
Print your name EXACTLY the way you want it to appear on the credential (titles such as Mr., Mrs., etc. will not be used):
Social Security # or Student ID #: ________________________
Telephone #: __________________________
Email address: ___________________________________________
Address Credential will be mailed to:
Credential Requested: ____ Certificate ____ Diploma ____ AA ____ AS ____ AAS
Area of concentration or major: __________________________________________________________
When was the credential awarded: Year ___________ Semester _________________
**Please note: Due to the use of an outside vendor, reprints of credentials may take up to 12 weeks from the date the form is submitted to the records office.
Office Use Only
Amount Paid: $______________ CASH _________ MO # ____________
Date Received: ________________ Received by: ______________________________