* Required

REPLACEMENT DIPLOMA REQUEST NOTE:

A replacement diploma displays the signatures of the current St. John Bosco High School Director, President, and Principal but shows the original date.

A Replacement Diploma is ONLY available for pick-up.

The fee for printing diplomas is $40.00 per copy.

Please allow a two month turnaround on diploma replacement requests.

Student Contact Information

First Namerequired

Middle Name

Last Namerequired

Name to be Printed on Diploma if Different from Above:required

Please enter N/A if it does not apply.

Date of Birthrequired (mm/dd/yyyy)

If, under the age of 18, your parent(s) or legal guardian will need to provide his/or her e-signature on this form.

SJB Student ID Number

Last Year Attendedrequired

Year of Graduationrequired

Home Addressrequired

Cityrequired

Staterequired

Ziprequired

Phone Numberrequired

DIPLOMA REPLACEMENT AUTHORIZATION NOTIFICATION

I, the requester for this replacement diploma request, warrant the truthfulness of the information provided in this application. My e-signature below constitutes an electronic signature and is the legal equivalent of my manual signature on this Replacement Diploma Request Form. My electronic signature also authorizes St. John Bosco High School to release information and/or my student record and confirms I have completed all sections accurately and truthfully, including information verifying my identity.

I understand that the recipient of the record(s) will use the indicated documents(s) for legitimate interests only and that the information contained therein shall not be further transferred or communicated to any other part or agency without my expressed written consent except under authority of Public Law 93-380, Educational Rights and Privacy Act.

I declare under penalty of perjury that the foregoing is true and correct.

Please check:*

I understand that by checking this box, I acknowledge and agree with the authorization notification stated above and agree that my electronic signature is the legal equivalent of my manual signature on this Replacement Diploma Form.

Your E-Signature:required

Fee(s) Information*

Diploma Replacement Request ($40)

Please send a confirmation email to the address below*: