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

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Hawaii State Department of Education

Kupono Diploma Application

HONORARY HIGH SCHOOL DIPLOMA FOR HAWAII ࠀࠁࠂࠃࠄࠅࠇࠪࠫ࠯࠼ࡀࡏࡐࡒࡔࡥࡱࢂࢎ࢔쫥꺼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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