Certificate Request Form

Certificate Request Form
IHS will send you a copy of a certificate based on your request below. This certificate will be sent to you via email. Please submit one request per course certificate you are missing. Please note, course providers have 30 days following the course to submit a roster of attendees to IHS. It is likely that IHS has not processed courses that were held in the last 60-90 days.If you would like to request an Official CE Transcript, visit this webpage. With questions, contact IHS Professional Development at (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: