DUE
APRIL 15
GMHS Diploma Request Form 2011
As a graduating GMHS senior, you have the opportunity to request a GMLSD employee to hand you your
diploma at the GMHS graduation ceremony. This person MUST be currently employed by, or retired from,
the Groveport Madison Local School District.
Any teacher, or other employee, from any building in the district may be asked to present the diploma.
OK

Your kindergarten music teacher can give your diploma if they still work anywhere in the district, or have
retired from the district.
NOT OK

Your kindergarten teacher went to work in Canal Winchester and still works there, or retired from there.
It is an honor for you to ask any staff member to present your diploma. Please ask the person personally if they
will be available the evening of May 27th to participate in the ceremony and present your diploma to you before
you turn in your paper.
---------------------------------------------------------------------------------------------------------------------------------------------------Student Name _______________________________________________
ID#_______________________
Contact Phone Number(s)______________________________________________________________________
Person I am requesting to hand my diploma to me: __________________________________________________
Building in which this person works: ______________________________________________________________
Contact Phone Number: _______________________________________________________________________
Contact Email Address: ________________________________________________________________________
Have person sign below.
I understand that the GMHS Graduation will be held the evening of May 27, 2011; I plan to attend to present
this diploma.
__________________________________________________
_______________________________
Signature
Date
You will be contacted prior to Graduation and given further details regarding the ceremony.
COMPLETED FORMS ARE DUE TO MS. ALLEN IN THE MAIN OFFICE AT THE HIGH SCHOOL BY APRIL 15.
LATE REQUESTS MAY NOT BE ACCEPTED