Credential Evaluation Application Form

PLEASE COMPLETE ALL SECTIONS OF THE APPLICATION AND ENCLOSE PAYMENT FOR ALL FEES

For a quick price quote, you may attach original language document in Word/pdf format to your message

1. Person whose educational credentials are to be evaluated

Last or Family Name:
First Name:
Middle Name:
Previously Used Names:
U.S. Social Security Number (If available. This number will be included on the evaluation report)
Mailing Address:
Address (cont.)
City:
State/Province:
Zip/Postal Code:
Country:
Work Phone:
Evening Phone:
FAX:
E-mail:

Birth Date:	Day:		Month:		Year:
Sex:	Male:		Female:

In what country (ies) were the educational institutions located?
Has this person submitted educational credentials to us before?	No Yes
If yes, Reference Number Assigned:
Have arrangements been made to have an institution (s) mail credentials directly to us?	No Yes
If yes, how is the name spelled on these credentials?

Who referred you to us?

If referred by a website, please provide URL address:

2. Types of evaluation reports & services

Check the type (s) of evaluation reports needed and fill in the amount.

	General	$125 US Dollars
	Course-by-Course	$150 US Dollars Each Course

Check the additional services needed.

Rush Service (check one):

	1 Day (available only for a General report)	$125 + $275 = Total $400.00
	4 Day	$125 + $175 = Total $300.00
	For mail options please see Service Options	Vary

Extra Copies:

$12.00 X

Unofficial Copy:

Fax Number:

$ 12 U.S. Dollars

Courier Service to:

	Address in Item 1 (within United States)	$55 Dollars
	Address in Item 4 (outside United States)	$75 Dollars

FILL IN TOTAL:

3. Purpose of evaluation

4. Evaluation report mailing instructions

	Mail both copies of the evaluation report to the mailing address in item 1 above.
	Mail one copy of the evaluation report to the mailing address in item 1 above, and one copy to the address below. (If you list more than one address below, a $10 copy fee is required for each additional address. Attach an additional sheet if necessary.)
Address:

5. Educational History

List all of the educational institutions attended, beginning with the first year of primary school and ending with the last year of education (including the school in which you are currently enrolled, if any). Print the name of each certificate, diploma, or title in English and in the native language. Add additional sheets if necessary.

Institution #1
Name of Institution
City & Country
Dates of Attendance FROM – TO
Name of Diploma, Certificate or Title awarded (if any)

Institution #2
Name of Institution
City & Country
Dates of Attendance FROM – TO
Name of Diploma, Certificate or Title awarded (if any)

Institution #3
Name of Institution
City & Country
Dates of Attendance FROM – TO
Name of Diploma, Certificate or Title awarded (if any)

Institution #4
Name of Institution
City & Country
Dates of Attendance FROM – TO
Name of Diploma, Certificate or Title awarded (if any)

FEES
Payment must be made in U.S. dollars by money order or check. If the money order or check is issued by a bank outside the U.S., it must contain the printed name of the U.S. bank with which the bank is affiliated. We cannot accept credit cards. All fees are subject to change without notice.

REFUNDS
A refund will be made only when the applicant has paid more than the cost of the evaluation report prepared by us. No refund will be made when an application is canceled after the application form has been submitted, or when all required documentation is not provided.

OTHER IMPORTANT INFORMATION
We reserves the right to contact educational and governmental institutions and agencies for additional information and/or verification of the authenticity of the credentials submitted.

If forged, altered, or falsified documents are submitted to us at any time, no evaluation report will be prepared, no refund will be made, the designees for copies of the report will be notified, and the information will be shared with academic institutions, government agencies, and other evaluation services.

We guarantees that each evaluation report will be prepared by its qualified professional staff. Equivalency conclusions stated in the evaluation report reflect the our judgment based on in-depth research in applied comparative education.

If we determines that the education completed is not the equivalent of credit courses offered by a regionally-accredited postsecondary institution in the United States, a General evaluation report will be prepared. If a Course-by-Course, Subject Analysis, Catalog Match, Health Professions Licensure report was requested, the difference in the cost between the report requested and a General report will be refunded.

Education is dynamic, and changes occur in all countries. Our on-going research may identify new equivalents for certain credentials from other countries, resulting in different statements of equivalence than were provided prior to the completion of such research. It is understood that all previous evaluation reports will have been based on the best information available to professionals in applied comparative education in the United States at that time. If copies of an evaluation report are requested at a later time, we have no obligation to review or revise the report in accordance with any changes that may have occurred in the interim.

6. Certification

I certify that all of the information provided in the application is complete and correct to the best of my knowledge.
I certify that I have read all of the information appearing on the application and instructions, and that I accept the terms and conditions stated therein.
I understand that evaluation reports prepared by Foreign Educational Credential Evaluators, Inc. are advisory, and are not binding on any institution, organization, or agency.
I release Foreign Educational Credential Evaluators, Inc. from any liability for damages resulting from the use of an evaluation report by me or any third party.
I release Foreign Educational Credential Evaluators, Inc. from any liability for damages to or loss of any documents submitted.
I understand that the information provided by Foreign Educational Credential Evaluators, Inc. on the application and instructions is subject to change without notice.

This application creates a contract between Foreign Educational Credential Evaluators, Inc. and the person who has signed the application. If the signer is not the person whose education credentials are being submitted for evaluation, the act of signing certifies that the signer is acting on behalf of the person whose educational credentials are involved, and has the authority to do so.

If you are not the person whose education credentials are being submitted for evaluation, what is your relationship to that person?

Today’s Date:

Day

Month

Year

Signature	(signature is required in order to process this request for an evaluation report.)
Name (printed)