Certificate Replacement

Segment 1 or 2 Certificate Replacement
Please provide as much information as possible to ensure we can process your request quickly. The most important Information is the full legal name, no nick names. Include the middle name and make sure spelling is as it appears on ID documents. Please make sure that your email is correct, as we will be emailing you a copy of the Certificate. You can then print it and keep a copy for your files. This copy will be considered a legal copy for all uses. There is a $20 fee for either the Segment 1 or Segment 2 Certificate. In the unlikely event you need both you will have to fill out this form twice. We tell our Students to put their certificates with their important papers , Birth Certificates, Social Security Cards etc, so look there first before you submit this form. Once you submit this form there are no refunds

We will be sending your certificate as an email attachment. Many email servers will filter emails with attachments to junk mail so please check there.
Which Certificate do you need
Location where you were enrolled

Other
Students Name

First NameMiddle NameLast Name
What was the Month of the class?
Email to send Receipt Notification and Certificate

Confirmation Emailexample@example.com
# to text If we can not find you.
Communication

Certificate Replacement

A printable copy of your Certificate will be emailed to you Print, and save the file for future use. Note: once you submit this request there are no refunds so take a second look now.

$20.00

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Segment 1 or 2 Certificate Replacement

Certificate Replacement