High School Diploma Application
          
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High School Diploma Application
Applicant E-Mail
Important: Enter a valid e-mail address. Correspondance will be sent to this address.
*E-Mail:
Applicant Information
*Student First Name:
Middle Initial:
*Last Name:
*Address Line 1:
Address Line 2:Apt. or Suite No.
*City:
*State:
*Zip Code:
Home Phone:
Work Phone:
Cell Phone:
*Date of Birth:
*Social Security Number
*Gender
Male
Female
Ethnic Origin:
Applicants must have all official high school
transcripts sent directly to our school if possible.
Education Information
*High School last attended:
*City/State:
*Last Grade Completed:
*Trade School or Other Formal Training?:
Yes No 
If Yes, Type of Training:
*Professional Licenses or Certificates?:
Yes No 
If Yes, what type?:
Is certification or license current?:
Yes No 
Military Service Information
*Military Service?:
Yes No 
If Yes, What Branch:
What was your rank upon discharge:
What was your speciality:
Lifestyle Information
*Are you a parent?:
Yes No 
How many children:
*Do you or have you ever played sports:
Yes No 
If yes, what sport:
*Do you or have you ever coached a sport:
Yes No 
If yes, what sport:
Any trophies or sports awards?:
Yes No 
BBall, bowling, karate, etc.
Alternate Contact Information
*First Name:
Middle Initial:
*Last Name:
*Address Line 1:
*City:
*State:
Zip Code:
*Phone:
E-Mail:
Payment
*Diploma Package:
Diploma Package:
PACKAGE INCLUDES:
Your High School Diploma
Padded Diploma Holder
Official Transcripts
Lifetime Verification Service
Verification Letters
Award of Academic Excellence
Grand Total:
By clicking the ``Submit Application`` button below, I hereby certify that all the
information I have given is accurate to the best of my knowledge.

I also understand that I am responsible for meeting the minimal criteria required for receiving my diploma.
*Signature: Enter first & last name
 

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in UPPER CASE.
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