HONORARY HIGH SCHOOL DIPLOMA APPLICATION
FOR LOUISIANA WWII, KOREAN and VIETNAM VETERANS
This form will be used by the Louisiana Department of Education and the Louisiana Department of
Veterans Affairs to establish eligibility for any Honorably Discharged WWII, Korean and Vietnam
veteran who did not receive a high school diploma or who does not possess a Louisiana High School
Equivalency Diploma and who would otherwise have graduated from high school between 1941 and
1955 and from 1964 to 1974. This diploma may also be awarded posthumously.
VETERAN’S NAME AND PERSONAL INFORMATION: (type or print legibly)
1. First 2. Middle (or initial) 3. Last 4. _____ MALE
5. MAILING Number, Street & Apt# City State Zip
6. Home Phone (include area code) 7. Date of Birth 8. Social Security Number
VETERAN’S MILITARY SERVICE INFORMATION: (Please attach a copy of discharge papers, if available.)
9. Branch of Service 10. Service Number 11. Highest Rank/Grade Attained
12. Periods of Active Duty Military Service: Date(s) Entered Date(s) Separated
Month Day Year Month Day Year
13. I certify that all the information I have provided is true and correct to the best of my knowledge.
I (do) (do not) authorize publication of my name as an Honorary Diploma Recipient.
Veteran’s Signature ____________________________________ Date _______________
**If applicant is someone other than the veteran, please provide the following:
Applicant’s Signature ___________________________________ Date _______________
Applicant’s Address __________________________________________________________
Relation to Veteran ___________________________ Phone: _______________________
** Please return application form and a copy of service discharge papers to: **
Louisiana Department of Veterans Affairs
Attn: Shannon Temple
P.O. Box 94095, Capitol Station
Baton Rouge, LA 70804-9095
TO BE COMPLETED BY DEPARTMENT OF VETERANS AFFAIRS & DEPARTMENT OF EDUCATION
Department of Veterans Affairs: Approved: _____ Disapproved: _____ Initials: _______ Date: _______
Department of Education: Approved: _____ Disapproved: _____ Initials: _______ Date: _______
Application may be downloaded from Department of Education website at www.louisianaschools.net.
For questions call the Department of Education Helpline at 1-877-453-2721.