Duplicate Certificate/Records Request

The SEE Center for the Advancement of Deaf Children
Request for a duplicate copy of the ESSE Certificate and/or ESSE Evaluation Results.
Full Name (current)*

First NameLast Name
Full Name (if different when the Exam was taken)*

First NameLast Name
Mailing Address*

Address

CityState / Province

Country
Note: The Certificate and Evaluation Results are mailed in a 9 x 12 envelope. Please provide an address that will accommodate that size envelope. Apartment mailboxes and PO Boxes are not recommended as mailing addresses.
Phone Number*
###-###-####
E-mail*
How many copies?*
Records requested:

ESSE Certificate $20Expressive Evaluation $10Receptive Evaluation $5Additional Certificate $5
Comments
Payment Information:
For payment by check or Money order, submit this form and mail the payment to:

S.E.E. Center for the Advancement of Deaf Children
P.O. Box 1181
Los Alamitos, CA 90720-1181
My Products

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USDAmount Owed
Your Certificate or Records will be mailed to you. The Shipping charge is included in the Processing fee when mailed in the USA. International shipping charges will apply.
Questions:

If you have any questions, please send an email to seecenter@seecenter.org or call us at (562)430-1467. Thank you!

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

The SEE Center for the Advancement of Deaf Children