TEXAS HIGH SCHOOL
DIPLOMA REQUEST FORM

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Name (Current Name): Date:
Address: Date of Birth:
City: State: Zip Code:
Phone Number: Cell Phone Number:
Name (at the time of attendance):
E-Mail Address:
Graduation Date: Pick-up    Mail
ATTACH THE FOLLOWING DOCUMENTS:
VALID DRIVER'S LICENSE WITH PICTURE
  • Cost for each Diploma request is $40.
  • Click here to pay.
  • Payment must be in the form of a Cashier's Check or Money Order made payable to Texas High School.
  • Payment must be received before order can be processed.
  • For mail in request: A copy of your Driver's License is required.
Mail Request Orders:
Texas High School
ATTN: Kari Haworth
4001 Summerhill Road
Texarkana, Texas 75503
For Office Use Only
Payment Received Date: ________________________ Amount: $40.00
Payment method: Cashier Check #:_______________ Money Order #:_____________________
Fund Request #:_______________________________ Purchased Order #:__________________
Ordered:_____________________________________ Received:__________________________
Received by:
Signature:____________________________________
 
Date:_____________________________
Date Mailed:__________________________________
*NOTE: ___________________________________________________________________