Application For High School Diploma For Michigan Wwii, Korean And Vietnam Era Veterans Form
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2Application for High School Diploma for Michigan WWII, Korean and Vietnam Era Veterans
Public Act 181 of 2001 as amended
This application is used to establish the eligibility of an honorably discharged WWII, Korean or Vietnam era veteran for
receipt of a high school diploma from the State of Michigan. Veteran must have attended high school in Michigan and
must have served in the military between December 16, 1940 and December 31, 1946 (WWII); June 23, 1950 and January
31, 1955 (Korean conflict); or February 29, 1961 and May 7, 1975 (Vietnam era).
Return the completed application to the veteran’s school district for processing.
VETERAN’S OR APPLICANT’S NAME AND PERSONAL INFORMATION: (Please print legibly.)
1.
First Name
2. Middle Initial
3. Last Name
Mr.
Mrs.
Ms.
4. Mailing Address
5. City
6. State
7. Zip
8. Relationship to Veteran
9. Daytime Phone
(Please include area code.)
(________) ________ - __________________
Self
Spouse
Brother
Sister
Child
Grandchild
Email Address:_______________________________________
VETERAN’S MILITARY SERVICE INFORMATION: (Please attach copy of discharge/separation.)
10. Name as Shown on Discharge/Separation
__________________________________
___________
__________________________________
First Name
Middle Initial
Last Name
11. Branch of Service
12. Service Number
13. Date of Birth
14.
Living
Date of Death
__________ / __________ / __________
_________ / _________ / _________
Day
Month
Year
Day
Month
Year
15. Periods of WWII, Korean or Vietnam Active Duty
Dated Entered
Date Separated
Military Service:
________ / ________ / ________
________ / ________ / ________
Month
Day
Year
Month
Day
Year
VETERAN’S DIPLOMA INFORMATION AND CERTIFICATION
16. Name of High School Attended in Michigan
17. City in Which High School Was Located
18. Years Attended
19_____ - 19_____
19. Name for Diploma
______________________________
___________
_______________________________________
First Name
Middle Initial
Last Name
20. I certify that I (or my ___________________) left high school before graduating for service in the military during World War II, the
Korean conflict, or the Vietnam era. I also certify that the information provided on this application and the supporting documentation
is true and correct to the best of my knowledge. (NOTE: Return the completed application to veteran’s school district.)
Signature_____________________________________________________________
Date___________________________
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