Verification Letter Request Form

Verification Letter Request
Candidate / Diplomate Information
First Name*
Middle Name
Last Name*
Date of Birth*

MonthDay Year
Date
ABR ID (if known)
Address to where letter will be sent
Individual / Company / State Name*
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Requester Information
Name*

First Name Last Name
E-mail Address*
Phone Number*

Area Code Phone Number
Who is requesting the letter?*

I am the candidate/diplomateI am a third party

Self Verification
Does the letter need to include your previous exam results? Note: If you are using the letter for state/licensing purposes, some states require the letter to include your exam results.*

Yes - I authorize the ABR to include pass exam resultsNo
Do you need a copy of the letter emailed to you?*

YesNo

Third-Party Verification
Does the letter need to include the candidate's / diplomate's previous exam results? Note: If you are using the letter for state licensing/permit purposes, some states require the letter to include exam results.*

NoYes - If selected, an ABR staff member will reach out to the candidate/diplomate to obtain his/her consent to release pass exam information.

Submission Process
- Once your form has been received by the ABR, you will be charged the applicable fee as outlined below:
  - Candidates/Diplomates requesting a self-verification will be charged $30.00.
  - Third-Party requests will be charged $100.00.
- Within 3-5 business days after submission of this request, an invoice will be sent via PayPay to the email address provided.
- The verification letter will not be processed until the fee is paid
- Please allow 3-5 business days for processing, after payment of fee.
For questions or concerns please contact: adminsupport@theabr.org or call
(520) 790-2900
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