American Speech-Language-Hearing Association

CE Registry Transcript Request Form

Please fill in the information below to request a transcript from the CE Registry. Please note: you are entitled to one free transcript for each year you pay the CE Registry fee. If you do not have a free transcript, the fee is $15 (member)/$20 (non-member). The CE Registry will contact you if you need to pay the transcript fee.

* indicated required field.

First Name:*

Last Name:*

ASHA Account Number:*

Mailing Address:*

City:*

State:*

Zip Code:*

 

This is a new address. Please update my account.

Phone Number:*

E-mail:*

Send Transcript to (if blank, transcript will be sent to mailing address listed in ASHA account):

Transcript to Include the Following Begin Date (MM/DD/YYYY):*

Transcript to Include the Following End Date (MM/DD/YYYY):*

Most Recent ASHA CEU Course Title:

Most Recent ASHA CEU Activity Date:

Most Recent ASHA CEU Activity Provider:

Most Recent ASHA CEU Activity City:

Most Recent ASHA CEU Activity State:

If the most recent activity does not appear on the transcript, please:*


I attest that the information provided is authentic and accurate. Additionally, I give ASHA permission to send my CE records to the organization or person indicated on this form.*

Share This Page

Print This Page