International Transcript Assessment Request Form printable pdf download

International Transcript Assessment Request Form

International Admissions Office

Phone (415) 338-2382

Fax (415) 338-6129

1600 Holloway Avenue, San Francisco, CA 94132

FAMILY/ LAST NAME,

FIRST/GIVEN NAME

MIDDLE NAME

INTERNATIONAL TRANSCRIPT ASSESSMENT REQUEST

INSTRUCTIONS FOR STUDENT

1). Print this form and complete all information below.

2). Contact International Admissions for initial screening and advising. Indicate the name of Admissions Counselor you spoke to and date of advising.

______________________________________________________

______________________________

Admissions Counselor

Date

3). Upon advisement by Admissions Counselor, submit the following to the Undergraduate Admissions Counter, One Stop Student Services Center:

Completed International Transcript Assessment Request Form

Copies of all transcripts, exams, diplomas, certificates, mark sheets, etc. from each international institution, university or college attended.

Copy of English translation of transcripts and academic documents.

Non-refundable $90.00 assessment fee. Cash or check payments are accepted at the Bursar’s Office.

STUDENT INFORMATION

Address _____________________________________________________

Social Security # (If available) _______________________________

_____________________________________________________

Birthdate (MM/DD/YY) ________/________/________

Planned Semester of Enrollment __________________________________

Intended Major ___________________________________________

Home Telephone ______________________________________________

Daytime/Message Phone ____________________________________

Citizenship Status _____________________________________________

Current Visa Status ________________________________________

E-mail ______________________________________________________

Sex (circle):

Female

Male

EDUCATIONAL HISTORY: List ALL (US and international) schools attended starting with high school/secondary school to present.

Diploma/Certificate/

Attendance Dates

Name of School & Location

Full or Part Time

Degree Earned

Your Age

From - To

International Transcript Assessment Request Form