College Prerequisite Equivalency Evaluation Form
Use this form to submit a completed course for review against a specific college prerequisite or required course.
Student and Institution Details
Student Full Name
*
First Name
Middle Name
Last Name
Student Email
*
example@example.com
Student ID
Institution Attended
*
Institution Type
*
Community College
Four-Year College
University
Vocational/Technical School
Other
Course and Equivalency Information
Completed Course Title
*
Course Code or Number
*
Subject Area or Department
*
Credit Hours or Units Completed
*
Course Start and End Date or Term Taken
-
Month
-
Day
Year
Date
Grade Earned
*
A
B
C
D
F
Pass
Incomplete
Other
College Prerequisite or Target Course for Equivalency Evaluation
*
Supporting Evidence and Evaluation Details
Is a syllabus available?
*
Yes
No
Upload syllabus
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of
Upload supporting documents (e.g., transcript, course outline)
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of
Evaluator remarks / notes
Evaluation status / preliminary decision
*
Please Select
Equivalent
Partially equivalent
Not equivalent
Needs further review
Submit Evaluation
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