Request Form For Ged Certificate & Official Transcript Of Ged Tests Results Form
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1REQUEST FORM FOR
GED CERTIFICATE & OFFICIAL TRANSCRIPT OF GED TESTS RESULTS
Please send the completed form and payment to:
ICCB-GED
P.O. Box 88725
Chicago, IL 60680-1725
Use this form to request a GED Certificate or Official Transcript of GED Tests Results and submit it with a money order or
cashier’s check payable to ICCB-GED for the total amount ($3.00 for each transcript and $10.00 for each certificate) to
the address above. Please allow 2-3 weeks for delivery. Fees paid are NON-REFUNDABLE. If you are ordering a
transcript and a certificate, the certificate will be sent separately. If you have any questions call (847) 328-9795.
Mark the number of each item you are requesting
.
[____]
Official Transcript: ($3.00 each)
Today's Date:
_________/________/________
[____]
$
Certificate ($10.00 each)
Total Amount Enclosed:
_____________
(Payment must be sent with this request form. Money order or cashier’s checks made out to ICCB-GED. We cannot accept any other form of
payment. No personal checks, cash, or credit cards will be accepted. Fees are non-refundable and non-transferable)
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Name Used at Time of Test:
_______________________________________________________________________
First Name
Middle Name or Initial
Last Name
Current Name:
_______________________________________________________________________
(If different from the name used at time of testing)
First Name
Middle Name or Initial
Last Name
Social Security Number or ID #:_____________________________
Date of Birth: _________/________/_________
Current Address:________________________________________________________ Apartment #:_______________
City:____________________________ State:________ Zip:___________ Phone Number:(____)_________________
Date of Test:
_________/________/_________ Test Center: _____________________________________
(approximately)
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Complete this section ONLY if this transcript is not being sent to you. (College, Company, Individual, etc...)
Name of college, company or individual: ________________________________________________________________
Attention:_________________________________________________________________________________________
Address:__________________________________________________________________________________________
City:____________________________________________________ State:_________ Zip Code:__________________
I authorize the Cook County GED Testing Program to release my GED scores upon request of the specified above to
the third party identified above.
Signature _________________________________________________________________ Date__________________
Please Keep a Photocopy for your Records!
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