HB 91 Diploma Petition Form

Please submit only ONE application per student. Submitting multiple petitions could result in a delay of the review process.


* Required Information
Student Information
*Legal name at time of enrollment:
*First Middle *Last

*Date of Birth: Month
select
Day
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Year
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*Gender:
*High School where student would have graduated:
select

*Expected Year of Graduation:
select

Student ID # (lunch number):
*Has student previously applied for a Waiver or Variance?
Primary Contact Information
*Name:
*Address Street 1:
Address Street 2:
*City:     *State: 
select
 *Zip: 
*Email Address:
*Phone Number:

*By clicking the "Agree" box, I verify the above information is complete and accurate. Agree