Duplicate Score Request

Personal Information

First Name:

First Name is required.

MI:

Last Name:

Last Name is required.

If your name has changed, please fill in your original name.

First Name:

MI:

Last Name:

Phone:

Phone number is required and must be at least 10 digits long.

Email:

Verify Email:

Email and Verify Email are required and must match.

Current Mailing Address

Address:

Current Address is required.

Address 2:

City:

Current City is required.

State:

Current State is required.

Zip:

Current Zip is required.

Country:

Exam Details

Testing Organization:

CRDTS

SRTA

Exam Location:

Exam Location is required.

Exam Date:

Exam Date is required.

If you have taken the exam more than once, please enter additional exam locations and dates:

Exam Type:

Exam Type is Required

Copy of Candidate Manual ($25):

Yes

Notarize ($4):

Yes

Address to Send Scores

First Copy Same as Current Mailing Address

Institute:

Address:

Address is required.

Address 2:

City:

City is required.

State:

State is required.

Zip:

Zip is required.

Country:

Country is required.

Second Copy

Institute:

Complete address information is required.

Address:

Address 2:

City:

State:

Zip:

Country:

Third Copy

Institute:

Complete address information is required.

Address:

Address 2:

City:

State:

Zip:

Country:

Comments

If you are submitting to WI, please provide your PAR # in the comments feild below.

Fee Information

Duplicate Score	$50
Copy of Candidate Manual	$25
Notarize	$4

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