Will you be able to attend the Celebration of Excellence graduation event on
Wednesday, June 11, 2008 at 6:30 p.m.
at the Ferst Center for The Arts (GA Tech Campus) in Atlanta?

Registration Information

Title First Name Last Name

Address

Address Line 2

City State Zip Code

Email address

Phone Number Alternate Number (Cell phone)

Independent Living Coordinator

County Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion McDuffie McIntosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond RockdaleSchleyScrevenSeminoleSpaldingStephensStewartSumterTalbot TaliaferroTattnallTaylorTelfairTerrellThomasTiftToombsTownsTreutlen TroupTurnerTwiggsUnionUpsonWalkerWaltonWareWarrenWashingtonWayneWebsterWheelerWhiteWhitfieldWilcoxWilkesWilkinsonWorth

Tell Us About Yourself
I am graduation from (Please provide graduation date and the name of your school):
      High School
      College
      GED Program
      Graduate School
      Other

If graduating from college, what is your degree/major?

      Please list your extracurricular activities:
             

Please list any awards or scholarships you have received:

Comments: