Request Form For Ged Certificate And/or Official Transcript Of Ged Test Results
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1
2D
P
R
O
E
U
AGE
EGIONAL
FFICE OF
DUCATION
REQUEST FORM FOR
GED CERTIFICATE AND/OR OFFICIAL TRANSCRIPT OF GED TEST RESULTS
Mail Request to: DUPAGE ROE – GED DEPT.
421 N. County Farm Road
Wheaton, IL 60187
Phone: (630) 407‐5800
[______] Official GED Transcript ($6.00 each)
Today’s Date: ______/______/_______
[______] Official GED Certificate ($10.00 each)
Total Amount Enclosed: $
______***
*** Mail In Request payment must be made via: Cash,
Cashier’s Check or Money Order made payable to DuPage
ROE. Walk In Requests may pay via above payment
methods or Visa/Mastercard. NO PERSONAL CHECKS
ACCEPTED. Fees are non-refundable and non-
transferable.
PERSONAL INFORMATION
Name Used at the Time of Test
:
(Proof of name change will be required)
First Name
Middle Name or Initial
Last Name
Social Security Number or ID #:
Date of Birth:
________/________/_______
Current Address
Apartment #
:
I do hereby certify that the above statements are true to the best of my knowledge:
City:
State:
Zip:
Phone Number:
(_____)
Date of Test:
Test Center:
(approximately) _______/_______/_______
Signature
TRANSCRIPT RECIPIENT INFORMATION
Complete this section ONLY if this transcript is not being sent to you. (Colleges, Employers, Institutions, etc.)
Name of College:
Attention: Office of Admissions and Records
Address:
City:
State:
Zip:
Name of Institution/Employer:
Attention:
Address:
City:
State:
Zip:
AUTHORIZED SIGNATURE
My signature below shows that I authorize my GED scores to be released to the requested address listed.
Signature:
Date:
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