High School Completion

This form is intended for completion following the student's high school graduation. It will not be processed until after the official high school completion date.

STUDENT INFORMATION

Last Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
First*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Middlefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Birthdate*field type date
Student ID #*field type single line
Must be 7 digits. Example 0123456.
Input blocked. Maximum character limit of 4000 characters reached.
Other names usedfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email Address*field type single line
example@mycod.us
Input blocked. Maximum character limit of 4000 characters reached.
Daytime Phone Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.

*field type radio button
I received a High School diploma from:I received my G.E.D from:I passed the California High School Proficiency Exam at
*field type single line
Name of School
Input blocked. Maximum character limit of 4000 characters reached.
*field type single line
City
Input blocked. Maximum character limit of 4000 characters reached.
*field type single line
State OR Foreign Country
Input blocked. Maximum character limit of 4000 characters reached.
I started attending this high school on*field type single line
MM/DD/YYYY
Input blocked. Maximum character limit of 4000 characters reached.
and graduated on*field type single line
MM/DD/YYYY
Input blocked. Maximum character limit of 4000 characters reached.
*field type single line
Name of School
Input blocked. Maximum character limit of 4000 characters reached.
on*field type single line
MM/DD/YYYY
Input blocked. Maximum character limit of 4000 characters reached.
*field type single line
City
Input blocked. Maximum character limit of 4000 characters reached.
*field type single line
State OR Foreign Country
Input blocked. Maximum character limit of 4000 characters reached.
*field type single line
Name of School
Input blocked. Maximum character limit of 4000 characters reached.
on*field type single line
MM/DD/YYYY
Input blocked. Maximum character limit of 4000 characters reached.

Allow 10 business days for processing.

I certify the information provided is correct.
Please Print your Full Name*field type single line
This constitutes as your e-signature
Input blocked. Maximum character limit of 4000 characters reached.
Date*field type date