DGAC Certificate Request Form

Read This First!

Please do not fill out this form if your class ended less than one month ago. Depending on mail delivery times and processing times, it can take up to four weeks for you to receive your certificate. Thank you.



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	CERTIFICATE REQUEST FORM

To receive a copy of your certificate, fill out the form below.

Basic Information

Your Name:
Phone Number:
Email Address:
Company Name:

How would you like us to send your certificate?
You may check both options, if desired.

Please fax my certificate to

Please mail my certificate to

Course Information

Which course did you attend?

Where did the course take place?

Please enter the date of the course:

All classes consist of lecture, work projects, question & answer sessions, and testing. Participants must attend all classroom sessions to receive a certificate. Students who arrive late and/or depart early will not be eligible for a certificate.
Please Note: There are two different types of certificates that you may receive upon completion of the course, and you will only receive one of these. If you completed all tests and quizzes with an average score of 85 percent or better, you will receive a certificate that states "Successful Completion" of the course. If your average score was below 85 percent, you will receive a certificate of attendance.

I have read and understand the statement above. Yes No

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This site was updated October 1, 2007, by Lisa M. Keyser. Although we attempt to keep this information up to
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