Duplicate GED Diploma Request Form - Nebraska

Duplicate GED Diploma Request Form

PO Box 94987 ? Lincoln, NE 68509 ? Phone: 402/471-2295 ? Fax: 402/471-0117

Print this page & mail with $2 cash, check or money order payable to: Nebraska Department of Education Complete and mail this form and payment to:

Adult Education Nebraska Department of Education PO Box 94987 Lincoln, NE 68509

Section 79-731 of Nebraska's Revised Statutes requires a fee of two dollars ($2.00) be charged for the issuance of a duplicate diploma. Upon receipt of your check or money order for $2 made payable to the Nebraska Department of Education and return of this release, we shall search our files for your records. If your records are found, we shall honor your request that a duplicate diploma be sent to the address you designate.

Print or type name you used at time of testing:

Approximate year diploma was issued: Send diploma to (print or type):

Name:

Street Address:

City, State, ZIP:

In order to release your duplicate diploma, we must have your signature below the following statement:

I hereby authorize the Nebraska Department of Education to release a duplicate of my GED diploma to the address above.

___________________________________________ Signature:

Printed/Typed Name: Street Address: City, State, ZIP: Social Security Number: Date of Birth: Testing Center:

Phone: E-mail Address:

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