Diploma Request Form

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    OPTIONS
    ACADEMIC ALTERNATIVE HIGH SCHOOL
    DIPLOMA REQUEST FORM

    To complete this form offline Download Here.
Name (Current Name): Date: Open Calendar Address: Date of Birth: Open Calendar City: State: Zip Code: Phone Number: Cell Phone Number: Name (at the time of attendance): E-Mail Address: Graduation Date: Open Calendar Pick-up    Mail
  • Payments must in the form of a Cashier Check or Money Order made payable to Jostens.
  • Payments must be received along with this request form before the order can be processed.
  • By signing this request form, you acknowledge the $40 charge for each diploma and agree to make payment in full before each diploma can be ordered.
  • For mail in request: Must send a copy of your driver's license.
Mail Request Orders:
OPTIONS Academic Alternative High School
ATTN: L. Michele Jones
4241 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: ___________________________________________________________________