AERC

Foreign Credentials Evaluation

General Equivalency Report

Detailed Equivalency Report

Documents Translation
Number of documents to be translated:

Other (please specify)

 

Please check and complete all questions.  Blank answers may delay processing.  Type or print clearly.

1. Applicant’s Name:
   
   Last Name
   First Name
   Middle Name


2. Sex:
   Male       Female



3. Name as it appears on documents if different from above:
   
   Last Name
   First Name
   Middle Name


4. Current mailing address:
   
   Street Address Apt. #
   City State/Country
   Zip Code


5. Home Phone:


6. Work/Cell Phone:


7. E-mail Address:


8. Date of Birth (month/ day/ year):


9. Place of Birth (State/ Country):


10. Years of Education Completed. Begin from first grade (check one):
    Less   8   9   10   11   12   13   14   15   16   17   18  More


11. List all educational institutions in chronological order, including elementary and secondary.  Must be completed by all applicants requesting evaluation.  Add additional sheets if necessary.
    
    

    Name of Institution

    City/ Country

    Dates Attended, From/To

    Name of Certificate / Degree / Diploma Earned

    Graduation Date

    Major

    
    
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12. Language of foreign records presented:


13. Country of records:


14. Purpose for which evaluation is intended:


15. Intended major in the US:


16. Name and address of institutions requesting evaluation(s):
    
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17. Do you want a copy to be mailed directly to the above listed institution(s)?
    
    Yes       No


18. How did you learn of our services?
    
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IMPORTANT

1. The undersigned has read, understood, and agrees to all terms and conditions specified in the applicant information section, and releases AERC from any liability for damages resulting from the use of this form. AERC is not responsible for documents lost, stolen, or damaged.
2. The undersigned authorizes the above listed educational institutions to release information to AERC.
3. The undersigned certifies under penalty of perjury that the information provided in this application and the records presented are true and correct to the best of his/her knowledge. Alteration or irregularities in records presented will result in such documents to be impounded or the information disseminated to the appropriate authorities.

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Signature

Date

 

 

REQUEST: (Additional Fee)

Rush evaluation
Additional Copies
Documents returned by Registered Mail

Documents returned by Certified Mail

Documents returned by Overnight Carrier (U.S.)

Lower and Upper division specification

ENCLOSED:

Credientials (original or official documents only)
Payment (Amount) $_______

FOR OFFICE USE ONLY:

D.R. EVAL

D.M. P.C.

F.L. R.