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Replacement Diploma Request Form

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Wayne County High School
Replacement Diploma Request Form
(Please Print)
Graduate Name: _________________________________________________________
                                                  (First)                                                         (Middle)                                                                 (Last)          
Name under which registered while attending Wayne County High School(Please include maiden name.) 
Year of Graduation: ___________________________
Date of Birth: ________________________________
Your Current Contact Information:
Address: ____________________________________________________________________
City: _____________________________    State: _______________ Zip Code: __________
Phone: ______________________________________________________________________
Signature:  ________________________________________________ Date: _____________
There is a charge of $ 25 for the replacement diploma. The diploma will be ordered upon receipt of cash, check or money order. Checks or money orders can be made payable to Wayne County High School. Allow 3-6 weeks for processing.
Mail To: Wayne County High School
Attn: Guidance Office
2 Kenny Davis Blvd.
Monticello, KY 42633