APPLICATION FOR HIGH SCHOOL DIPLOMA FOR : World War ll / Korean Conflict / Or Vietnam Conflict Veteran

Date Of Application

Veteran :

First	MI	Last	Date Of Veterans Death

Address	City

County	State	Telephone

Applicant :

( If Not Veteran )	FULL     NAME

/

RELATIONSHIP TO VETERAN

Address	City

County	State	Telephone

Last school Veteran attended prior to entering service :

SCHOOL	CITY	COUNTY

YES	NO Did Veteran leave school to serve in Armed Forces Of United States ?

Did Veteran leave school due to family circumstances and subsequently enter the Armed Forces of the United States ?

Did Veteran receive a High School Diploma ?

Remarks (Optional )

Veterans Certification : I / Veteran left school in order to serve in the Armed Forces of the U.S, or due to family circumstances and subsequently entered the Armed Forces of the U.S.

Signature Of Veteran or Applicant on Behalf of Veteran	Date

School or District from which Veteran is requesting High School Diploma

Did Veteran serve in Armed Forces of U.S. between 9/16/40 to 12/31/46, between 6/27/50 to 1/31/55, or between 8/5/64 ( 2/28/61, for veterans who serced "in country" before 8/5/64) to 5/7/75 ? ( Circle period of service )

Verified by :

Ohio County Veterans Service Officer	County of VSO

( As of 1-06 previous editions of this form are obsolete) ( County Veterans Service Officer : Forward application immediately to the board of education of any city, exempted Village or local school district or governing authority of any chartered non-public school or county education service center in Ohio )