High School Attestation Form

91��

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High School Attestation

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This field is for validation purposes and should be left unchanged.
I,
Name*
First Last
(legal name), have applied for admission to the College of Arts & Sciences at 91��. I understand that one requirement for admission to 91�� is graduation from a high school or successful passing of a high school equivalency exam.
I hereby certify that:*
- I graduated from high school.
- I earned a high school equivalency.
Type of Equivalency (GED, HiSET, etc.)*
Name of High School*
Address of High School*
City State / Province / Region Country
Date of Graduation*
MM slash DD slash YYYY
Student Information
Legal Name During High School
First Last
Date of Birth
MM slash DD slash YYYY
If for any reason this attestation of high school graduation or high school equivalency completion is found to be false or untrue, I understand that I will not have met an admissions requirement of 91��, and I will not be considered a regular student, and, thus, will be subject to immediate dismissal from 91��.

I understand that if this attestation is found to be false or untrue, all Title IV financial aid and any state or institutional financial aid that was distributed on my behalf must be refunded to the appropriate source and that I will be responsible for payment to 91�� for any and all money refunded.

By my signature below, I attest that the information provided above is true and correct to the best of my knowledge. Further, I authorize 91�� to contact my high school or high school equivalency exam administrators to confirm the accuracy of the above information.
Email*
Date*
Signature*
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Signature
Please note that completed forms must include a valid signature. Forms submitted without a signature, will not be accepted. Before submitting, please ensure that your signature is visible below.

91����

High School Attestation

91��