Richland Two Act 155 Petition Form

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Richland Two Act 155 Petition Form
A person, no longer enrolled in a public school, who was denied graduation solely for failing to
meet the exit exam requirements (S.C. Code Section 59-18-310(B)) may petition the local school
board of trustees to determine his or her eligibility to receive a high school diploma. Pursuant
to Act 155 the local district where the person completed graduation requirements will receive
the petition, determine the person’s eligibility to receive a high school diploma, and request a
diploma. All petitions must be filed by December 31, 2015.
Please complete this petition in its entirety. You must use your FULL NAME as displayed on your
BIRTH CERTIFICATE. Fax a copy of a valid photo ID to (803-738-3308), or email a scanned copy
to . Incomplete information will delay processing. Please see the Richland
Two Act 155 Guidelines or the South Carolina Department of Education Information on Act 155
for specific information or email Katinia Davis at . Please allow 8-10 weeks
for processing, printing and delivery.
* Required
First Name:
*
______________________________________________________
As displayed on your birth certificate
Middle Name: _____________________________________________________
As displayed on your birth certificate
Last Name:
*
______________________________________________________
As displayed on your birth certificate
Current Mailing Address: ___________________________________________
___________________________________________
Phone Number:
*
__________________________________________________
Please provide your cell or reliable number where we can contact you.
Email Address: ___________________________________________________
Which high school did you attend?
*
_________________________________
What year would you have graduated high school?
*
___________________
If my petition is approved, I request that my diploma be...
presented at a School Board meeting.
mailed to my current address.
picked up.

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