Exam Score Verification Request

Exam Candidate Information
Candidate Name

First NameLast Name
Potential alternative name(s) tested under:
Name of Examination
Date of Examination
Please provide the estimated year if you do not know the exact date.
Administering board jurisdiction

Verification Recipient Information

Individual/Entity to receive the Exam Score Verification Letter.
Delivery Method:

Please note that email delivery is typically the preferred method of most credentialing agencies.

If you are a professional seeking to send your verification to an organization or credentialing agency, you will automatically be cc'd on the verification email notice.
How would you like the verification letter sent?
Send to:
Receiving Individual/Organization Name
Attention to:
(if applicable)
Receiving Individual/Organization Email:
example@example.com
Receiving Individual/Organization Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Exam Score Verification

$25.00

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Disclaimer: While International Certification & Reciprocity Consortium (IC&RC) uses every reasonable effort to provide accurate and up-to-date information, we make no warranties or representations as to the accuracy of the content and assume no liability or responsibility for any error or omission in the content.
Acknowledgement
Should be Empty:

Exam Verification Letter Request