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Secondary Education Confirmation

Student Name:

Program:

Start Date:

Funding Source:

Please check the appropriate box and complete the requested information. (check only one)

I affirm that I have graduated form an accredited High School and have received my High School Diploma.

Name of High School:

Street Address:

City, State, Zip Code:

Year of Graduation:

I affirm that I have received my General Equivalency Diploma (GED):

State Issuing GED:

Month and Year GED awarded:

I affirm that I have not graduated from High School nor have I received my GED

Highest Grade Completed:

Signed Date:

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Timestamp

Audit

April 27, 2020 9:51 am EDT

Secondary Education Confirmation Uploaded by Brenda Evans - [email protected] IP 71.143.223.187

May 1, 2020 9:35 am EDT

CTE Enrollment - [email protected] added by Brenda Evans - [email protected] as a CC'd Recipient Ip: 71.143.223.187