Form for Requesting Simple Verification of GED

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Form for Requesting Simple Verification of GED Powered By Docstoc
					       The Department of Elementary and Secondary Education
       75 Pleasant Street,                                        Telephone: (781) 338-6625
       Malden Massachusetts 02148                            TTY: N.E.T. Relay 1-800-439-2370




                   Form for Requesting Simple Verification of GED
                  (Fax number–781-338-3089 Attn: GED Office)

  To be filled out by the agency/company/person requesting verification:
Individual’s Name:

If different name when tested, please indicate:

SSN:

Date of Birth:

Date GED Received:

Please attached Release Form or have individual sign here:

(ALL INFORMATION MUST BE PROVIDED IF REQUEST IS TO BE PROCESSED.)


Name of Agency /Company / Person Requesting Information:

Contact Person:

Fax:

Phone:

(RESPONSE WILL BE RETURNED WITHIN 48 to 72 HOURS FROM DATE REQUEST
IS RECEIVED AT GED OFFICE)


FOR GED OFFICE USE ONLY:

         Information Missing: _____________________________________________

         No Record Found

         Received GED                              Award Date: _________________


Test Center where Score Report Located:
____________________________________
(Telephone numbers & addresses located on our web site www.doe.mass.edu/ged)




                                                                         Effective /rev.11/`10/10

				
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