HOUSTON COUNTY SCHOOLS 1100 Main Street – P.O

HOUSTON COUNTY SCHOOLS 1100 Main Street – P.O. Box 1850 Perry, Georgia 31069 478-988-6200 O.C.G.A. § 20-2-281.1 PETITION FORM An individual (hereinafter referred to as “Student”) no longer enrolled in a Georgia public school and who previously failed to receive a high school diploma in this state or was denied graduation solely for failing to achieve a passing score on one or more portions of the Georgia High School Graduation Tests or its predecessor or the Georgia High School Writing Test or its predecessor may petition the local board of education in which he or she was last enrolled to determine the Student’s eligibility to receive a high school diploma pursuant to O.C.G.A. § 20-2-281.1 based on the graduation requirements in effect when the Student first entered ninth grade. Submit this completed, signed form by mail or in person to the school the student last attended (see attached list of school addresses). If submitting a petition by mail, include a scanned/copied image of your government issued photo identification. A photo ID will also be required if submitting in person. Incomplete information may delay processing. STUDENT’S PRIMARY CONTACT INFORMATION Name Phone Number Email Address Home Street Address City State Zip Code STUDENT INFORMATION Provide Legal Name if Different from _____ Primary Contact. First Middle Last Did student go by any other name in high school? If yes, what name? Male / Female Date of Birth Last 4 digits of SSN Gender (circle) Name of High School from which student would have graduated Year Student Completed High School I verify the above information is complete and accurate. Student’s Signature: Date: FOR OFFICE USE ONLY The Petitioner has met the requirements to receive a regular high school diploma. Transcript was verified by ____________ on ________________________(date) Date diploma issued: ________________________ The Petitioner has not met the requirements to receive a regular high school diploma. Signature Position School Please mail or take this completed form to the Guidance Office of the high school that you last attended: HOUSTON COUNTY CAREER ACADEMY 1311 Corder Road Warner Robins, GA 31088 HOUSTON COUNTY HIGH SCHOOL 920 Highway 96 Warner Robins, GA 31088 NORTHSIDE HIGH SCHOOL 926 Green Street Warner Robins, GA 31093 PERRY HIGH SCHOOL 1307 North Avenue Perry, GA 31069 VETERANS HIGH SCHOOL 340 Piney Grove Road Kathleen, GA 31047 WARNER ROBINS HIGH SCHOOL 401 South Davis Drive Warner Robins, GA 31088 .

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