PLEASE PRINT

Social Security Number:

Date of Birth:

Year GED Completed (or best guess): *Do not call if you don't know!

Name at Time of Testing:

Authorize the TEA/GED Unit to release any information regarding my GED certificate to:

PLEASE PRINT

Name:

Address:

City/State/Zip:

Phone Number: Fax Number:

Email Address:

Signature: ___________________________________ Date:

REQUESTS WITHOUT APPROPRIATE SIGNATURE WILL NOT BE PROCESSED.

Mail to:

Texas Education Agency
Education Services/GED Unit CC:350
1701 North Congress Avenue
Austin, Texas 78701-1494

OR FAX to: (512) 305-9493

For help completing this form contact the Texas Education Agency GED Unit
Phone: (512) 463-9292

Suggestions or comments may be submitted to Texas GED Unit