Verification Letter Request Form

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

Month Day 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/diplomate I 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 all exam results, including pass and fail results No
Do you need a copy of the letter emailed to you? *

Yes No

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. *

Yes - I have attached a signed release from the candidate / diplomate No
Candidate / Diplomate Release

Browse Files

Cancel of