OUT OF STATE/CITY DIPLOMA REQUEST FORM
This form is for students and families who no longer reside in New York City to request their diploma be mailed to their new address. (THIS IS NOT FOR TUDENTS ATTENDING COLLEGE OUT OF STATE)

In order to have the diplomas mailed out, students must complete the following acknowledgements on this form:

• Attest that they are unable to pick up their diploma in-person,
• Provide consent to having their diploma mailed, and
• Acknowledge that their diploma cannot be replaced if lost, stolen, or damaged (but proof of graduation can be provided upon request).
Email address *
1. Student Last Name *
2. Student First Name *
Un9-digit NYCDOE Student ID Number *
Date of Birth *
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DD
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Mailing Address (Number and Street Name) *
Apt # (if applicable) *
City and State(example: Albany, New York) *
Zip Code *
Email address *
Phone number *
I attest that I am unable to pick up my diploma in-person. *
I consent to having my diploma mailed to me at the mailing address provided on this form. *
I understand that the diploma will not be replaced in the event of damage, theft, or loss. I understand that I may obtain copies of my Official High School Transcript by properly submitting in writing a request for official high school records. *
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This form was created inside of Tottenville High School.