Certification Exam Extension Request Form
Submit your request to extend your scheduled certification exam date. Please provide all required information for consideration.
Candidate Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Candidate ID or Student Number
*
Institution or Organization
*
Certification Exam Name or Type
*
Originally Scheduled Exam Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Extension Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you previously requested an extension for this exam?
*
No
Yes
Reason for Extension Request
*
Upload Supporting Documentation (if applicable)
Upload a File
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Choose a file
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Additional Comments (optional)
Submit Extension Request
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