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CHSPE CERTIFICATE/TRANSCRIPT ORDER FORM

A CERTIFICATE/TRANSCRIPT ORDER FORMCHSPE Please PRINT carefully or type all information requested below. California High School Proficiency Examination For information, call 866-342-4773. PERSONAL INFORMATION Last Name (Please specify the name used at the time of testing.) First Name Middle Initial Date of Birth Approximate Test Date CHSPE ID # (if known) PERSONAL CONTACT INFORMATION Name only if your name has changed Mailing Address City State ZIP Code Daytime Phone Number _____ - _____ - _____ Evening Phone Number _____ - _____ - _____ E-mail (if available) ORDERS FEE PER UNIT X QTY = TOTAL FEES DUPLICATE certificate (S) The $25 fee is charged for EACH duplicate certificate ordered.

Certificates and transcripts will be mailed via first-class mail within ten business days of receipt of this order form. If you request and pay for Rush

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