Application for Honorary High School Diploma for WWII Veterans

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					      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
                                                                                _____ FEMALE
5. MAILING           Number, Street & Apt#             City                               State            Zip
ADDRESS:

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.
        Circle one

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
                                   Phone: 225/922-0500
                                    FAX: 225/922-0511
  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.