Release of Information

Educational Interpreter Performance Assessment Release of Information

Performance or Written Tests
Name

First NameLast Name
Name as it appears on the test

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Date of Birth

MonthDayYear
Identification Verification
Please attach a copy of your valid government ID.

Browse Files

Cancelof
Date and Location of Test
Please check the appropriate box below. Each copy is $25.00.
PLEASE READ:

EACH COPY IS $25.00.

YOU WILL RECEIVE AN INVOICE VIA E-MAIL WITH A LINK TO PAY BY CREDIT CARD.

ONCE PAYMENT IS RECEIVED YOUR DOCUMENTS WILL BE SENT BY USPS MAIL. EIPA DOES NOT E-MAIL TRANSCRIPTS.

IF THE INVOICE IS NOT PAID WITHIN 5 DAYS, YOUR REQUEST WILL BE CANCELLED.
I understand and agree to the invoicing process as stated above.
I am authorizing that a copy of my report and scores be mailed to:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional information that may help EIPA process your request.
Comments
I understand that checking this box constitutes a legal signature and is the legal equivalent of my manual signature.
Signature
Should be Empty:

Educational Interpreter Performance Assessment Release of Information