Document Request Form

Student Name *

First

Last

Email *

Confirm Email

Phone *

Date of Birth *

Which School Location? *

POLY Languages at Irvine
POLY Languages at Los Angeles

If you have attended more than one center, you must complete this form separately, one per center.

Please select the documents you need.

All the fees below are NOT refundable.

Certificate

Certificate of Achievement/Completion ($20)

Certificate of Achievement is awarded to those who have successfully completed (C or better) the courses: RW 601, RW 602, LS 601 and LS 602. This certificate serves as our testament that the student has demonstrated proficiency in all four skills of the English language: Speaking, Listening, Reading, and Writing. Certificate of Completion is given to those who have successfully completed (C or better) at least one course from a listening/speaking series and a reading/writing series. The certificate will indicate the highest levels successfully completed from the listening/speaking series and the reading/writing series.

Enrollment Verif.

Enrollment Verification ($20)

Enrollment Verification certifies the period that a student has enrolled. For a continuing student, the form may also indicates the projected period of enrollment for the student. For ex-students who have completed their program more than 10 year ago and the school has no record of the students, the school will only provide a letter testifying that we do not have the record and it is not fault of the student.

Transcript

Official Transcript ($25)

An official transcript is a complete representation of a student’s attendance and academic record. It includes all courses attempted at POLY Languages Institute, including those withdrawn from and those repeated. For ex-students who have completed their program more than 10 year ago and the school has no record of the students, the school will only provide a letter testifying that we do not have the record and it is not fault of the student.

Student ID

Student ID ($20)

For a Student ID, a student’s photo must be uploaded. There are several guidelines for the photo to be acceptable. The photo must be taken in front of the background approved by the administration office. Contact the administration office for assistance in taking the photo for the Student ID.

Do you need Rush Service?

Rush Service ($25) – The processing time is 10 to 20 days for all documents. If you select the Rush Service, the processing time will be within 10 days. For the Student IDs, the processing time is 20 to 30 days, and the Rush Service does not apply.

How would you like your documents to be delivered? *

By mail outside the US ($80)
By mail within the US ($40)
Pickup-in-Person ($0)

For mailing packages, we use courier companies that have a tracking system to ensure their delivery. You may opt to pickup-in-person (free of charge) at the following address: 5757 Wilshire Blvd., Suite 510, Los Angeles, CA 90036.

Mailing Address – International *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Message

Total Due:

$0.00

Assisted by (Optional)

State the name of the advisor who assisted you in completing this form.

Stripe Credit Card *

Card

Name on Card

Acknowledgement and Agreement *

I understand and agree that the service fees indicated herein are not refundable. Furthermore, if I have selected the Pickup-in-Person for the delivery method, I agree to pick the requested documents within 90 days from the date this form is submitted. Otherwise, I understand that the requested documents will be discarded without any refund.