Certificate Request Form

Certificate Request Form
IHS will assist you in obtaining a copy of your certificate based on your request below. Please submit one request per course certificate you are missing. If you would like to request an Official CE Transcript, visit this webpage. With questions, contact IHS Professional Development at professionaldevelopment@ihsinfo.org or (734) 522-7200.
Please note: IHS processes all requests within one week and often sooner. Be sure to check your spam/junk folder for emails from IHS. For best results, add "ihsinfo.org" to your email provider's "whitelist."
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Last 4 Digits of SS/SI Number*
Date Course was Held*

MonthDayYear
Date
Title of Course You Attended*
Course Provider (i.e. Oticon, Widex, AudiologyOnline, IHS, FSHHP, etc.)*
Course Format*

Web-Based Online CourseLive Course
Course Location*
If Web-Based Online Course, type "N/A"
Please verify that you are human*
Should be Empty: