Degree and Certificate Replacement Request

Name(Required)

First Name Middle Initial Last Name (when enrolled)

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Reason for Request(Required)

Graduation Date(Required)

Degree(Required)

Concentration

Major(Required)

Minor

Certificate

Check One:(Required)

Bachelor of Science

Bachelor of Arts

Certificate

Master of Education

Master of Business Administration

Name on Degree at time of Commencement(Required)

First Middle Last

Name as you want it to appear on Replacement Degree or Certificate(Required)

Replacement Degree Fee

Price:

Purchase Voorhees College Degree Cover

Price: $25.00

(Only graduates prior to May 2022)

Total

Credit Card