Duplicate Ged Diploma Request Form

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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:
Shirley Gruntorad
Adult Education
Nebraska Department of Education
PO Box 94987
Lincoln, NE 68509
Section 79-4.147.02 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:
Phone:
Social Security Number:
E-mail Address:
Date of Birth:
Testing Center:

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