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1Request for Transcript of GED
Test Scores
®
GED test-taker: Please provide the following information to help us locate your GED test
records. Your signature is required in the space provided.
Note: If you are a third party requesting information on behalf of a GED test-taker, the test-taker
MUST complete and sign this release form.
GED Test-Taker Information:
Name at time of testing: __________________________________________________________
Date of birth (00/00/0000): _____/_____/__________
Social Security Number (000-00-0000): _______-_____-__________
Current address: ________________________________________________________________
City: ______________________________________ State: _______ Zip:___________________
GED Testing Center where GED Tests were taken:_____________________________________
Approximate year of test: __________
Daytime phone number (with area code): (______) ______-__________
Check appropriate box(es):
Please send _____ transcript(s) to me at the address above.
Please send _____ transcript(s) to ______________________________ at the address below.
(Person/employer/institution)
Signature of GED test-taker:
_______________________________________________________ Date: _________________
Please mail transcript to:
Name of institution (if applicable): _________________________________________________
Last Name: __________________________ First Name: _______________________________
Street: ______________________________________________________ Apt. No.: _________
City: ______________________________________ State: _______ Zip:___________________
Print out, sign, and mail this request to:
Commonwealth Diploma Program
th
333 Market Street, 12
Floor
Harrisburg, PA 17126-0333
A nonrefundable processing fee of $3.00 is required for each transcript requested. Please submit a
money order payable to the Commonwealth of Pennsylvania. Allow 2-4 weeks for processing.
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