Secondary Education Confirmation
Student Name:
*
Student Name
Program:
*
Start Date:
*
-
Month
-
Day
Year
Date
Funding Source:
*
Please select the appropriate box and complete the requested information.
*
I affirm that I have graduated from an accredited High School and have received my High School Diploma.
I affirm that I have received my General Equivalency Diploma (GED).
I affirm that I have not graduated from High School nor have I received my GED.
Name of High School:
*
Street Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Year of Graduation:
*
State Issuing GED:
*
Month and Year GED Awarded:
*
Highest Grade Completed:
*
Signed Date:
*
-
Month
-
Day
Year
Date
Your Legal Name:
*
Your Email Address:
*
example@example.com
I agree by signing and submitting this form to be legally bound by this agreement.
Signature
*
Agree and Sign
Should be Empty: