Pemberton Township High School Diploma Request

Pemberton Township High School Diploma Request Form
- Please fill out all required fields on this form.
- The cost for your request is $25 per copy.
- If you wish diploma copies to be mailed to you:
  - Payment must be in the form of check or money order made out to "Pemberton Township High School"
  - Payment must be received before diploma copy is mailed to you.
  - Payment should be mailed to:
    Pemberton Township High School - Diploma Requests
    ATTN: Amy Longoria
    148 Arney's Mount Road
    Pemberton, NJ 08068
    NOTE: Cash payments will ONLY be accepted in person. Please do not send cash though the mail.
- Payments can be made in person upon pick up and be in the form of cash, check or money order made out to "Pemberton Township High School"
Frist Name
Middle Name (or Initial)
Last Name
Maiden Name (if married)
Year of Graduation*
Number of requested copies*
E-mail*
Complete Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
mailing my payment to the specified address.paying in person at the time of pickup.
Phone Number*

Area CodePhone Number
Special Instructions & Requests
Anti Spam*
Total Cost = $
Should be Empty:

Pemberton Township High School Diploma Request Form