Course Record Request

Course Record Request
Please note that this form is to request a course record. Course records are used to verify completion of CCEF courses and are not a certificate. There is a $10 fee for each official course record you request. A credit card payment is required to submit this form.
Consent*
I understand this and want to proceed.*

Name*
First Last
Maiden Name
Email*
Student Personal Address*
Please type the address correctly as it will be included on your course record.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Student Daytime Phone*
Date of Birth*
MM slash DD slash YYYY
Where would you like your course record to be mailed?*
- Westminster Theological Seminary
- My personal mailing address
- My email
- Another institution mailing address
- Another institution email
Please type the name of the institution.*
Please type the address of the institution.*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please type the email address where we should send your course record.*
Who should the email be addressed to?*

Payment Information
Billing Name
First Last
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Course Record Cost*
Price:
Credit Card*
Card Details
Cardholder Name
Email
This field is for validation purposes and should be left unchanged.

Course History