ATTACH $25 PROCESSING FEE FOR EACH REQUEST
(Make check or money order payable to
the appropriate licensing board.)
If you are requesting that your exam scores be submitted with your request for certification, please complete and forward the attached form with your request for certification. Please be aware that most states do not require exam scores, please check with the licensing authority prior to requesting this information.
Waiver of Confidentiality and Authorization to Release Scores Form
Certification to be sent to: