Educational Records Evaluation Service, Inc.

2480 Hilborn Road, Suite #106

Fairfield, CA 94534, U.S.A.
Founded 1981; Member of NACES since 1993; BBB A+;

Phone: 707-759-2866 w [email protected] w www.eres.com

Application for Education Evaluation

Print out this form, fill it out completely in ink, and follow the instructions on Pages 3 & 4.
1. Full name (printed) as you wish it
to appear on the evaluation report:______________________________________________________________________________________
First Middle Family Name (or Last Name)
2. Other names appearing on your school records: 5. Home: ( _____ ) _______ - ________
Mobile: ( _____ ) _______ - ________
Best time to call: __________________
If your name on the school records is different from #1 above, you must submit a copy of 6. Date of birth: *______/_____/_______
your Marriage Certificate or Court Order, etc. to verify your name change. If not, we will Month / Day / Year
use the name(s) given on your school records. (*4Important: Write Birth Date Clearly;
4Please Use Letters for Months, such: Jan, Feb..)
3. Address
You are: o Male o Female o X
Native Language:_____________________
7. Date submitted: _____/_____/________
E-mail Month Day Year
* VERY IMPORTANT–PRINT CLEARLY, ALL CAPITAL LETTERS-Your
Evaluation Can Be Delayed when Email is NOT Clear. 8. Turnaround Time: Normally 5-7 weeks.

4. 1 Check here to have report mailed to an address (below) different from 9. Have you ever had an evaluation with us?
above: Note: Requires Service M1 Fee (below) for Certified Mail.
o Yes o No
Contact Name
Previous Reference #: _____-_____-______
Address

Reminder: Do you need to have your original documents back after report is completed? (Must Choose One)
1Yes, I agree to pay mailing fee (On No.12) for ERES to mail back my originals. Or 1Yes, I will pick up my originals in ERES Office (Fairfield).
1No, by checking this, I understand ERES will destroy all my originals.
10. List below ALL secondary schools, colleges, and universities that you have attended. Attach extra pages if necessary.
Level of Year Year Diploma, Degree, Title you earned
Institution Country
Education Entered Left as written on original documents

11. 1Be sure to submit documents for the above schools: See Item #10 on Page 4.
12. Using code letters from the attached Fee Schedule (Page 3), circle the services you are requesting. Indicate how many in the box:
Services: HP HG U C G Q TT TS V R15 R10 R5 R1 R0 M1 M2 I E1 E2 F1 F2 F3
How
Many? o o o o o o o o o o o o o o o o o ooooo
Ÿ Rush Service (R15, R10, R5, R1, R0) requires that TOTAL payment be by Money Order (or Cash). 1 Total Payment: $___________

FOR OFFICE USE ONLY

Reference #: __ __ - __ __ - __ __ __ Amount paid: $ ______ Transaction: _________
Date received: __ / __ / __ Initial: _____ Initial: _________
Due Date: __ / __ / __ Subjects #: _____ (PKG: ____; Page: ____;)
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(Continued from page 1)
13. Please use this space for additional information if necessary:___________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
14. Check the primary purpose(s) for which you are requesting this evaluation:
o Admission to an educational institution: Name of school: ____________________________________________________
o Employment or promotion
o Professional license: oArchitecture, oAcupuncture, oDentistry, oLaw, oMedical Doctor, oReal Estate,
o Speech Language Pathology, o Substitute Teaching, o Teaching Credential, oOther: __________________________
o Accounting license: Choose one: o For CPA Exam; o For CPA Licensure; Which State Board: __________________
The completed evaluation is mailed directly to the Accounting Board Representative. Put Board Address in Item 4 (Page 1)
o Immigration
o Military enlistment or promotion
o For future reference, no immediate purpose
o Other purpose: ______________________________________________________________________________________
15. How did you first hear about our services? Check all that apply.
o School admission advisor. Name of school/name of advisor: _________________________________________________
o Employer personnel officer. Name of company/name of officer:_______________________________________________
o Government agency. Name of agency: ___________________________________________________________________
o Contact by ERES representative. Name: __________________________________________________________________
o Advertisement. Name of publication: ____________________________________________________________________
o Yellow Pages directory
o Internet search engine (without referral from another source)
o Friend/relative who used our services previously
o Other: _____________________________________________________________________________________________
16. Please read our Terms & Conditions and Privacy Policy.
By checking boxes below,
o I understand this evaluation cannot be processed without COMPLETE required ORIGINAL documents.
o I have read and agree to the ERES Terms & Conditions.
o I have read and agree to the ERES Privacy Policy.
THESE TERMS AND CONDITIONS (together with the ERES Terms & Conditions found at http://www.eres.com/ERES-Terms-and-Conditions.pdf
and the ERES Privacy Policy found at http://www.eres.com/ERES-Privacy-Policy.pdf (the “Privacy Policy”), referred to as the “Terms” is made
as of the date upon which the individual to whom the Application applies (the “Applicant”) executes such Application (the “Effective Date”) by
and between Educational Records Evaluation Services, Inc., a California Corporation (together with its subsidiaries and affiliates hereinafter
collectively referred to as “ERES”) and the Applicant, as identified in the Application.

My signature below attests to my agreement with all such terms and conditions stated above.
Signature of applicant: ______________________________________________ Date: ______/______/______
Month Day Year
17. Payment Type: o Online Payment (Please leave #18 blank, and check email for invoice) o Credit Card (#18 is Required)
o Personal Check o Money Order o Cashier’s Check o Cash
Reminders: Ÿ Please check your email for invoice if you prefer online payment. Evaluation will not begin processing until payment arrived;
Ÿ If your documents need to be mailed back to you, you must pay the M1 ($20) Fee-See M1 Page 3;
Ÿ Rush Service (R15, R10, R5, R1, R0) requires that TOTAL payment pay by Money Order, Cashier’s Check (or Cash/Debit Card if
paying in person).

18. To Pay by Credit Card, give ALL the information requested below: Type of Card: o Visa o MC o Discover o AMX o Debit Card

Name of Card Holder (Print): ____________________________; Holder’s Phone#:___________________________________

Billing address (if it is different from #2): ______________________________________________________________________________
_________/_________ /_________/_________ ______ / ______ _______________ $ __________ ______________________________________
Account number on credit card Expiration date 3 digits security code Amount Signature of credit card holder
on back of card Authorizing Payment
19. Before submitting this application, check that all items have been answered fully. An incomplete application may delay the
processing of your evaluation.

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 ERES GENERAL EVALUATION FEE SCHEDULE
For Nursing-Use Other Forms
We are pleased to have the opportunity to work closely with you to associated dates, the documentation you submitted, our research
determine the equivalency of the education you received outside the references and other relevant details. Our evaluation is advisory in
United States of America. Our application form is simple, and on Page nature and subject to the policies of the institution to which it is
4, we have some helpful tips for you to make it even easier. If you have submitted.
questions, please call or send us an e-mail. Paying for our services
Below are the fees we charge for normal evaluations and the code Payment must be made by check or money order (payable to E.R.E.S.)
letter to mark on your application. You will be notified if your or by Visa/MasterCard/Discover/AMX at the time you submit your
evaluation requires additional fees. After we determine that the application. If you use a credit card, fill out the blanks at the end of the
application is complete, the evaluation process begins and there application form. If you send us a personal check, your evaluation may
is no refund for cancellation. be delayed. Penalty for checks returned for non-sufficient funds is
An ERES evaluation is a multi-page report which describes the purpose $25. For rush service (R15, R10, R5, R1, & R0), payment for all services
of your evaluation, the programs you attended and their U.S. requested must be made by Cashier’s Check or Money Order.
equivalency, the status and location of schools you attended and w All fees are subject to change without notice. W

Note: Evaluations normally take 5 to 7 weeks to complete.

See Below for Rush Options. Then Mark All Chosen Code on Bottom of Page One (#12).
n BASIC EVALUATION: (Must Choose H, U) t RUSH SERVICES (Pay Total with Cash or Money Order) t
HP High School Grade-Level Placement $220 15_Day Rush Service* (ready to pick-up or be mailed in
Our evaluation helps you be admitted to high school by describing R15 15 or 16 business days after receipt of complete application $65
the education you have received and a list of your courses/subjects & payment. *Usually 15 days (sometimes 16 days)
with the U.S. equivalent high school credits, and grades. We also 10_Day Rush Service* (ready to pick-up or be mailed in
recommend the grade level at which you should start high school in R10 10 or 11 business days after receipt of complete application $95
the U.S. & payment. *Usually 10 days (sometimes 11 days)
HG High School Graduated ONLY (High School Completion) $165 5_Day Service* (ready to pick-up or be mailed in 5 or 6
General Evaluation (College Level) R5 business days after receipt of complete application & $145
U $195 payment. *Usually 5 days (sometimes 6 days)
(College Degrees up to 3 programs and Course List Not Included)
This will certify the highest U.S. equivalent level of education you 1-Day & Same Day Rush Service 1-Day: $235
R1 (Call ERES to check availability). Same-Day: Call
attained: ALL college/university levels up to, and including, the *Counting Rush Service Days begin the next day when complete order is received
equivalent of a U.S. Baccalaureate, Master’s or Doctoral degree. after 11am. Usually evaluation without rush service will take 5 to 7 weeks to
complete.
Over three (3) programs or institutions or unusually complex
education may incur extra charge: $40 per program t MAILING SERVICE (See Bottom Page 4) t
n ADD ANY OF THE FOLLOWING SERVICES YOU NEED Certified Priority Mail Fee __ ($20 Applies for
C Course List (Up to 60 Courses*): Add to ‘U’ above $100* M 1
each address: Such as __ when documents & report $20
(U.S. are mailed to same address fee is $20; when (U.S. Address
Only)
We list all your post-secondary courses, the U.S. equivalent semester Only) documents & report are sent (separately) to different
ASHA: American Speech Hearing Association

units of credit and grades. In most cases, we will indicate the Level addresses fee is $40 (2 x M1), etc. (M1: U.S. Address Only)
SPL: Speech Language Pathology

(lower and upper division, or graduate level) for each course at no M2 1 to 2 Day Express Service __ Completed report $35
(U.S.
extra charge. Secondary (High School) courses also can be listed upon Only) is delivered in 1 to 2 days. (M2: U.S. Address Only) (U.S. add. Only)
request. Return of original documents and/or reports by
Available only with ‘U’ above. I courier to all countries check for pricing ($100 Variable
(International)
*For CPA Evaluation Course List is $130 (NOT $100) or above)
ç*For SLP/ASHA Evaluation Course List is $150 (NOT $100) t EXTRA COPIES w REVISIONS w CANCELLATIONS t

*Transcripts with over 60 courses require additional payment Copy: An official copy of your evaluation
Ranging: Extra $30 (61-70); $50 (71-80); $100 (81-110); $150 (111-150) E1 requested after the initial application) $35
$200 (150 and above). -See Copy Order Form
Grade Point Average (GPA): Up to 3 Programs
ONLY Available when you also Selected “C” (above)
G $50 E2 Each Additional Copy with Initial Request $25
Over three (3) programs of institutions may incur
extra charge: $15 per program
Q Consultation (30-minute Appointment) $35 Above Copy Options DO NOT Apply to Nursing Evaluation
t TRANSLATION & VERIFICATION SERVICES t t REVISION t
Translation of transcripts up to 60 courses (C)
over 60 courses require additional payment Revision of a previous evaluation based on new
TT $100 F1 $70
Ranging: Extra $30 (61-70); $50 (71-80); $100 (81-110); $150 information __ small to moderate changes
(111-150) $200 (150 and above).
Translation of up to 3 Translated Info is put into evaluations;
F2 Revision of a previous evaluation $100
TS Diplomas $10 per extra NOT separately translated $40 Based on major changes
F3
Rewrite of a previous evaluation: Sometimes About
V Verification of translation $50 necessary for a variety of reasons $150
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 Helpful Tips and Instructions for Completing the Application
For Assistance – Please email ERES: [email protected]. Be sure to give your name as it appears (or will appear) on the application; Give your case# if you have
it. Include your phone#. Try to maintain the email stream from prior email if possible. Give careful, thoughtful details of your situation, unless details are in
the email stream. Sometimes including scan copies of documents or your past evaluation can help. Put something specific to your case in the subject line.

The Numbers Below Refer to the Questions on the Application

#2: You must show that you are the same person named Submit the documents in both the original native
on your educational records. If any of your records refer language and translated into English. Translations should
to you by a name different from what you listed in #1, list have the school seal or be prepared by a certified U.S.
that name and attach a copy of your marriage license or translation service. ERES can provide translation services
some other documentation that shows your name has for Arabic, Chinese, French, Italian, Japanese, Russian, &
been legally changed. If you cannot provide Spanish, etc. See Items TT and TS, on the Fee Schedule,
documentation of an official change in your name, we will Page 3. Call ERES if you need assistance finding a
not use the name you listed in #1; instead, we will use the translation service.
name(s) given on your official educational records.
Submit only original, official documents issued by the
schools you attended. If you have already submitted your
#4: An M1 fee (see Fee Schedule on Page 3) will apply
official documents to a school or agency that requested
when your official evaluation is mailed to an address
the evaluation, you should have “Certified True Copies” of
different from #3. you will always receive an unofficial
the documents send directly to us from the school or
copy of your evaluation whether you use one or two
agency. Nursing Board applications must have transcripts
addresses.
sent directly to ERES from the schools attended.
#8 & #9: Ordinarily the evaluation is completed within 5 #17 & #18: Check carefully that your application is
to 7 weeks after your application is complete but compete before mailing. A complete application consists
occasionally can be nearly 3 months. See page 3 for a of the documents from the schools listed in #10 above
Rush Service & #9 on Page One and add the appropriate and the payment for the total of all the services you have
fee to your payment. (See Items: R15, R10, R5, R1 and R0 on requested. When complete, send your application
the Fee Schedule-Page 3.) package to us. Note that we are not responsible for your
documents during the time they are in the hands of the
#10 & #11: It is important that you provide complete postal service or other delivery service.
information for ALL the schools you have attended at
each level of your education, even if you no longer have Five-Year Availability–after five years you will NOT be
official records from them. (Your pre-college documents able to order copies of your evaluation. Generally after
may not be necessary.) Give the name of each diploma, five years a new evaluation would need to be prepared if
leaving certificate, degree, or title you earned. more official copies are needed. Please consider ordering
extra official copies if you think more copies may be
You must submit ALL the educational documents issued needed after five years.
to you by the schools you wish to have included in the
evaluation (transcripts, diplomas, certificates, etc.). For } Note: You have 60 days after you receive your
graduate level degrees, diplomas and certificates, you evaluation to carefully check it and then to notify ERES if
must include the undergraduate documents (transcripts, you think changes are necessary. After 60 days there will
diplomas, etc.) that lead to the graduate program. be a FEE for changes.

More Important Information

¿ Important-An Official Copy is put in a sealed envelope 4If you use a Rush Service (R15, R10, R5, R1 or R0) and want
& should be given to your employer & school, or licensing guaranteed overnight delivery of Your Official Evaluation,
board UN-opened. choose M3. If you choose a rush service (R15, R10, R5, R1 and R0),
you must pay for all services requested, including R15, R10, R5, R1
¿ Mail Delivery of Evaluation & Documents: and R0, by cashier’s check or money order. (For Rush
4Official evaluations are sent out only by: Certified translation could add additional days; For R1 and R0, call ERES
Priority Mail (M1 on Fee Schedule), by Express Mail (M2 on to check availability)
Fee Schedule) or by Overnight Courier Service (M3 on Fee
Schedule). ¿ Please Note:
If your documents have been altered, or if they
4Documents are returned (for security reasons) ONLY by
misrepresent the truth in any way, no evaluation will be
Certified Priority Mail-M1 (Unless picked-up from our
prepared and no refund will be made and the documents
office).
will not be returned to you. We will advise other
4When an official (sealed) report and documents are evaluation agencies regarding our rejection of your
mailed to the same address only ONE M1 fee applies ($20), documents.
but if mailed to TWO (separate) addresses, then TWO M1
fees apply ($40).
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