Exam Score Verification Request

Exam Candidate Information
Candidate Name*

First NameLast Name
Potential alternative name(s) during time of testing:
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 included on the verification email notice.
Send to:*
Receiving Individual/Organization Name
Attention to:
(if applicable)
How would you like the verification letter sent?*

via Emailvia Regular MailBoth
Email verification to:
example@example.com
Mail verification to:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Payment Information*

Exam Score Verification

$25.00

Total

$0.00

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 Score Verification Letter Request