Kupono Diploma Application - Hawaii DOE
|MAIL TO: HAWAII STATE DEPT. OF ED. |Phone: (808) 271-5724 |Website: |
|KUPONO DIPLOMA PROGRAM | |Email: doe_info@ |
|PO BOX 2360 | |Applications will be accepted at any time. **However, applications must|
|HONOLULU, HI 96804 | |be submitted no later than January 30th to participate in the current |
| | |year graduation ceremony. |
|A COPY OF THE APPLICANT’S HONORABLE DISCHARGE PAPERS (DD-214) OR INTERNMENT PAPERS MUST ACCOMPANY THIS APPLICATION |
|General Information about Hawaii Veteran or Wartime Internee (See #20 below, if applying on individual’s behalf) |
|1. First Name |2. Middle Initial |3. Last Name |
| | | |
|4. Mailing Address |5. City, State |6. Zip Code |
| | | |
|7. Contact Phone/Cellular |8. Email | |
|( ) - | | |
|Military Service Information |
|9. Branch of Service |10. Service Number |11. Highest Rank/Grade Attained |
| | | |
|12. Active Duty Military Service |
| |
| |
|Date Entered Service Date Released From Service |
|Month / Day / Year Month / Day / Year |
| |
|_____________________ _________________________ |
| |
|_____________________ _________________________ |
|Civilian Information |
|13. Internment Site |14. City, State |15. Dates of Internment |
| | | |
|Hawaii State Public High School - Diploma Information |
|16. Hawaii Public High School Attended |17. High School Years Completed |18. Original Projected Graduation Year |
| | | |
|19. Diploma Presentation – The applicant would like to: |
|____ PARTICIPATE in a recognition ceremony (May of current year) |
|____ have the honorary diploma MAILED to the applicant’s address noted on this application |
|If applying on behalf of a Hawaii veteran/former internee, please provide the following information: |
|20. First Name |21. Last Name |22. Relationship to applicant |
| | | |
|23. Mailing Address |24. City, State |25. Zip Code |
| | | |
|26. Contact Phone/Cellular |27. Email |28. Is the veteran/former internee deceased? |
|( ) - | | |
|I certify that the information provided is true and correct to the best of my knowledge |
|Print Name |Signature |Date |
| | | |
|For Office Use Only |
|DOE | Approved Disapproved |Processed by: Date: |
|File # |Reg # | |
HIDOE-KDP APPLICATION (11/2008), REV 3/2015
-----------------------
Hawaii State Department of Education
Kupono Diploma Application
HONORARY HIGH SCHOOL DIPLOMA FOR HAWAII ࠀࠁࠂࠃࠄࠅࠇࠪࠫ࠼ࡀࡏࡐࡒࡔࡥࡱࢂࢎ쫥꺼貝橻筙㝈㝈奪奪筪ᔠ繨漋ᘀꉨ㼨䌀ᑊ伀Ɋ儀Ɋ帀Ɋ愀ᑊᔠ繨漋ᘀ譨٥䌀ᑊ伀Ɋ儀Ɋ帀Ɋ愀ᑊᔠ繨漋ᘀㅨ噍䌀ᑊ伀Ɋ儀Ɋ帀Ɋ愀ᑊᔠ繨漋ᘀ걨콑䌀ᑊ伀Ɋ儀Ɋ帀Ɋ愀ᑊᔠ繨漋ᘀ牨䌀ᑊ伀Ɋ儀Ɋ帀Ɋ愀ᑊᔠꙨ㡲ᘀ앨㍍䌀ᙊ伀Ɋ儀ɊVETERANS AND WARTIME INTERNEES
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