High School Graduation Certification Form - California

First Name MI Last Name Social Security Number or CSAC ID or DREAM ID
(Please circle one)
Address City State Zip Code
Email Address:
High School Graduation Certication Form
For the Entitlement Cal Grant Program
Earlier this year the California Student Aid Commission (Commission) offered you an Entitlement Cal Grant to
help pay for your college expenses. Prior to receiving your Entitlement Cal Grant, you must submit conrma-
tion of your high school graduation to the Commission. Use this form to verify that you have graduated from
high school and meet this requirement for your Cal Grant. Read the information on the reverse side to help
you complete this form correctly.
A I have completed all of my high school requirements, and graduated.
If you checked A, above, please ll in the items below.
Month and year of graduation:
Name of high school or agency:
City, state, country of high school:
Or
B I have passed the California High School Prociency Examination (CHSPE). Issue Date: ________
Or
C I have passed the General Education Development (GED) Test. Issue Date: __________________
Or
D I do not meet any of the three statements above.
Student Certication: By signing the certication below, I am afrming that I have completed all of my high school graduation
requirements, including passing the CAHSEE exam if required by my school. Or, I have passed a high school equivalency test
such as the California High School Prociency Examination or the General Education Development (GED) test. I understand
that it is illegal to report false or misleading information. I have read the information printed above and certify under penalty of
perjury under the laws of the State of California that the information above is true and correct.
Signature
Day time telephone number Date
Attention: Conrmation of your high school graduation is required or no Cal Grant payments can be released.
You can certify this online at https://mygrantinfo.csac.ca.gov or at www.webgrants4students.org.
Step 1 Please check the box of the statement that best ts your educational status.
Step 2
Fall 2014 College of Attendance:
G-8 (02/14)
See reverse side for more information
Please note that the CHSPE is not the California High School Exit Exam (CAHSEE)
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High School Graduation Certification Form - California PDF

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