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

First Name Last Name
Mailing Address *

Address

City State / 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 $20 Expressive Evaluation $10 Receptive Evaluation $5 Additional 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
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USD Amount 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

Please click one of the PayPal options to complete payment and submit the form.

The SEE Center for the Advancement of Deaf Children