State of Tennessee

Participating School 12th Grade Students Graduation and Completion Form

Directions: By Aug. 20 of each year, participating schools will have to report all of their 12th grade students who participate in the ESA program as one of the following: graduated, completed, withdrew from the school, repeating 12th grade, or other with explanation. Participating schools will define graduation as a student who has received a regular diploma or a special education diploma.

Participating schools will define completion as a student who has taken and passed the HiSET or GED.

If a school doesn't have any students enrolled who are in the ESA program and who are graduating/completing high school, the school must email esa.questions@tn.gov by the deadline above to report to the department that the school does not have any students who are graduating/completing.

Name*

First Name

Last Name

Job Title*

Email*

Phone*

School Name*

Date*

Do you have any participating 12th grade students who are graduating or completing the program this year?*

Yes No

If "yes," you must upload a document listing these students. If "no," you will be taken to the end of this form to submit.

Below, you must upload, in spreadsheet or PDF form, a document that includes all participating 12th grade students. You must include each student's:

First and last name
Date of birth
Whether or not they have:
- Graduated,
- Completed the program,
- Withdrew from the school,
- Are repeating 12th grade, or
- Other (with an explanation).

If the student is listed as "completing the program," please indicate which exam the student passed to complete the program (HiSET or GED).

Upload*

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By signing below, you certify the information provided in this form, including any supporting documentation is
truthful and accurate. You further understand that if any false statements or documentation is
provided, the department may prohibit the participating school from enrolling in the ESA
program in the future.

Signature*

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