SCORE REQUEST FORM

Step 1: Personal Information
Date of Request:
Name at time of exam:
Current First Name: MI: Current Last Name:
SSN:
Email:
Telephone:
Mailing Address:
City: State: Postal Code:

 


Step 2: WREB Exam Taken (leave year blank if you have not taken a WREB exam)
Dental Exam
Dental Hygiene Exam
Local Anesthesia Exam (Dental Hygiene Candidates only)
Restorative Exam (Dental Hygiene Candidates only)
Exam Year:
Exam Year:
v
Send Score Information to: (For example: you or name of a state board)
Mailing Address:
City: State: Postal Code:

 


Step 3: Scoring Information Needed (click question mark help to see descriptions and samples)
Please Check Your Choice:

  • Success Report  help $30.00
  • Individual Performance Report  help $30.00
  • California Dental Exam Non-Failure Verification  help $50.00
  • California Dental Hygiene Exam History  help $75.00
  • Louisiana Licensure (Never Taken WREB) Letter  help $50.00
  • Certificate of Passing  help $50.00
  • Dental Hygiene Summary Profile Sheet  help $75.00
  • Exam Content Explanation  help $50.00
  •  
  • Expedited Shipping $50.00