Diploma Request in Accordance to Act 155
A person (hereby referred to as "student") 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 to determine his or her eligibility to recieve a high school diploma. For more information about ACT 155 visit http://www.ed.sc.gov/newsroom/public-information-resources/high-school-exit-exam-elimination/.
Please submit this form online by pressing the submit button. OR you may print and submit the completed, signed form by mail to: Janet Howe, Student Records Office, 1 Men Riv Drive, Goose Creek, SC 29445. OR submit in person at the Student Records Office. Incomplete information will delay processing. Allow 8-10 weeks for processing, printing and delivery.
Primary Contact Information
Primary Contact's Name: ____________________________________________________
Primary Contact's Phone: ________________________________
Primary Contact's Email: _________________________________
Primary Contact's Current Address: ____________________________________________
                                        City: ____________________________
                                        State: _________________  
                                        Zip Code: ______________
Personal Information
Student's First Name*: __________________________________
Student's Middle Name*: ________________________________
Student's Last Name*: __________________________________ Students Generation(Jr., II, Etc)**: _________
Did student go by any other name in high school? If yes, what name?** ________________________________
Student's Date of Birth: _________________
Previous School Information
High School Name from which Student Would Have Graduated: ___________________________
School Year in which Student Would Have Graduated: ____________
*Should be the name given on the Student's Birth Certificate.
**NOT a required field. All other fields are required.

I verify the above information is complete and accurate. Student's Signature: _____________________________________________

****************************BELOW TO BE COMPLETED BY AN OFFICIAL*******************************
Photo ID or sight validation accepted:    Yes    No      Initial:____
Student's Name on Record: _____________________________________________
School Year in which student would have graduated: _______
Number of credits required during graduating classes of 1990-2000 is 20. # Completed: ______
Number of credits required during graduating classes of 2001-2014 is 24. # Completed: ______
Did student complete the required number and types of units:    Yes    No
             If no, what unit(s) were incomplete: _________________________________________________________________
Student meets all requiremetns to recieve a diploma:    Yes    No
Official's Signature: __________________________________     Official's Printed Name:__________________________________