Fillable Form 22701.: Official Score Transfer Request Form

Fill Online, Printable, Fillable, Blank Form 22701.: Official Score Transfer Request Form Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Form 22701.: Official Score Transfer Request Form

On average this form takes 9 minutes to complete

The Form 22701.: Official Score Transfer Request Form form is 1 page long and contains:

  • 2 signatures
  • 5 check-boxes
  • 24 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Official Score Transfer Request Form
ASWB Score Transfer Form 10/2020
You may use this form to request that ASWB send an official copy of your exam results to an additional licensing board after you have passed
the examination. COST: $40.00(US) nonrefundable fee for EACH board specified. You must first submit your licensure application to the
jurisdiction before submitting the Score Transfer Request.
Online:
By mail:
By fax:
Go to https://www.aswb.org and click on “Exam Candidates” on the opening page. Only credit card payments (Visa, MasterCard,
Discover) will be accepted when ordering online
Fill out this form completely and mail to ASWB with a certified check, money order or credit card information (Visa, MasterCard,
Discover). No personal checks will be accepted. Mail to: ASWB Candidate Services, 17126 Mountain Run Vista Ct., Culpeper, VA
22701.
Fill out this form completely and fax to ASWB at 540.829.0142. Be sure to fill out the credit card payment information. Only credit
card payments (Visa, MasterCard, Discover) will be accepted when ordering by fax.
Last Name First Name MI
Address: _______________________________________
________________________________________________
PAYMENT INFORMATION
SCORE TRANSFER INFORMATION
Card Number:
Last three digit
s from back of card EXP DATE: (month/year)
Cardholder’s billing ZIP/Postal code: _____________________
Cardholder’s nam
e: ____________________________________
Cardholders’ Signature: _________________________________
Indicate below the state(s)/province(s) to which the score
report should be sent:
State(s)/Province(s):
TOTAL: ______ score tr
ansfers @ $40.00 each = _______
Exam taken:
Associate
Bachelors/Basic
Masters/Intermediate
Adv. Generalist/Advanced
Clinical
Date taken: (mon
th/year)
I attest that all the information provided in this score transfer order is true and accurate. I further attest that I am transferring my
scores for the purpose of submitting an application for licensure with one of the licensing jurisdictions of Canada, the United
States, or a U.S. territory. I understand that the board should receive the score report within seven to ten business days. It is my
responsibility to follow up with the board to be sure that the report has been received. I understand that I must contact ASWB
within 1 year of placing the order if the score report has not been received by the board. If I do not contact ASWB within this 1
year time frame, I will have to pay the US$40 fee to reorder the score transfer report.
Signature: ____________________________________________ Date: ___________________________________
IMPORTANT: If your name has changed since you took
the ASWB exam, name change documentation is
requir
ed. You will need to submit the name change
documentation along with this form.
Legal Documentation accepted: Marriage certificate,
divorce decree, or court ordered document.
If your information was different at the time you tested,
please provide the original information below.
______________________________________________
Last Name First Name MI
SSN (US)/SIN (Canada): ______________________________
Address: ______________________________________________
____________________________________________________
Daytime telephone: ______________________________________
Birthdate:
Email Address: __________________________________________
______________________________________________________
Please complete the following with your CURRENT information.
0
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Form 22701.: Official Score Transfer Request Form

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 27 May 2022

Message

View Audit Log
Print With Audit Log
Duplicate Document