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Josef Silny & Associates, Inc.

Mail applications to: International Education Consultants
7101 SW 102 Avenue Tel.: (305) 273-1616
Miami, FL 33173 Fax. (305) 273-1338/Translation Fax: (305) 273-1984
E-Mail: [email protected]
OR EMAIL TO:
Web Site: www.jsilny.org
[email protected]

Application for Evaluation of Foreign Educational Credentials

for Boards of Nursing
Information on Josef Silny and Associates, Inc., International Education Consultants (JS&A)

JS&A is an organization of highly qualified international education consultants. Mr. Silny is recognized nationally and internationally as an
expert in the field of foreign credential evaluations and international admissions. He has been the Director of International Admissions at the
University of Miami and the City University of New York. He has participated as a panelist or workshop director at national professional
conferences annually since 1974. He has held numerous committee chairmanships and memberships in national professional organizations
and corporations. Mr. Silny has published a book and numerous articles in the field of international education. All international education
consultants associated with Mr. Silny are highly qualified in the field of foreign credential evaluations. JS&A is a member of the National
Association of Credential Evaluation Services, Inc. (NACES)

APPLICATION PROCEDURES - Please be sure to read the complete information on our website at www.jsilny.org.

PLEASE BE AWARE THAT WE WILL NOT PROCESS YOUR REQUEST FOR ANY SERVICE UNLESS WE RECEIVE YOUR FILLED-OUT AND
SIGNED APPLICATION AND CORRESPONDING FEES. JS&A WILL NOT BE RESPONSIBLE FOR DOCUMENTS SENT TO US. IF ACADEMIC
CREDENTIALS ARE SENT TO US FROM ISSUING INSTITUTIONS, BE SURE THAT WE RECEIVE YOUR FILLED OUT APPLICATION WITH
PAYMENT FIRST.

In order to receive an evaluation, an applicant must provide the following:

1. A completed Application for Evaluation of Foreign Educational Credentials signed by the applicant
2. A non-refundable evaluation fee in U.S. dollars. Make the bank check or money order payable to Josef Silny & Associates, Inc. (We
cannot accept postal money orders or payments through Western Union). If you are paying by a credit card you must fill out the Credit
Card Information form. All evaluation fees, including fees for rush report, 24-hour report, grade point average equivalent, extra copies,
and translation are NON-REFUNDABLE.
3. EDUCATIONAL DOCUMENTS:
a) Official diplomas and certificates in the original language
b) Official transcripts in the original language (names of courses, grades, and hours of instruction) for every year of study
c) A Syllabus of university studies (description of each course or subject studied) is required
4. TRANSLATIONS: Documents in a language other than English must be accompanied by professional, certified English translations.
Translations supplement, but do not replace the original documents. JS&A offers professional certified translations. JS&A is a
Corporate Member of the American Translators Association. For further information on the JS&A Translation Service, call 305-273-
1616 or e-mail or fax your request for translation estimate along with all pertinent documents.
E-mail: [email protected] Translation fax: 305-273-1984
Processing Information: For nursing licensure: transcript, degree, course descriptions, and filled out charts must be sent by the issuing
institution(s) directly to JS&A and will be verified. In addition, we need to receive directly from the issuing authority, applicant’s nursing
license, date issued, date of expiration and if the applicant’s license was ever revoked or suspended. Academic credentials received directly
from foreign institutions are considered confidential and cannot be given to applicants. The documents you submit with your application,
with the exception of any originals, will become the property of Josef Silny & Associates, Inc. and they will not be returned. When it has
been determined that documents submitted for evaluation or translation were forged or altered in any way, no evaluation report or translation
will be prepared and the fees will not be refunded. All recipients indicated on the application form will be notified. It is the applicant’s
responsibility to submit the documents which need to be evaluated. If the application is not completed within one year, JS&A will close the
file. A new evaluation fee will be required for updating the file. JS&A will keep applications with academic credentials for one year only.
Please note that all fees are subject to change without notice. Refusal of service: JS&A reserves the right to refuse service to anyone. In
preparing an evaluation report, every effort is made to consult appropriate resources, in order to provide the most accurate evaluation
possible. JS&A will provide a list of the references used in making the specific evaluation upon written request. JS&A does not discriminate
among applicants as to the age, sex, race, religion, national origin, disability, or marital status.

02/23/2023
PROCESSING TIME
1. Standard Processing Time: Evaluations are normally prepared in 10 to 15 working days from the receipt of all required fees, information,
documentation and verifications. Evaluations which require extensive research and correspondence may take longer to prepare.
2. Rush Evaluation Reports
a) 24-Hour Evaluation Report b) 2-Day Evaluation Report c) 5-Day Evaluation Report
Rush evaluation reports will be completed in a timely fashion, in accordance with the type of rush evaluation report requested, upon receipt of all
required fees, information and documentation. If, for any reason, the evaluation report cannot be completed within the specified time after receipt of
all required fees, information and documentation, the rush fee will be refunded and the evaluation will be completed as quickly as possible. The rush
fee will be adjusted to reflect the actual processing time and a refund of the difference will be issued. Rush evaluation reports must be paid for by
bank check, money order or credit card.

COST OF EVALUATIONS
1. Nursing Course-by-Course – U.S. $400 (Licensure only). The cost for each additional state board is $400
2. 24-Hour Evaluation - U.S. $300 in addition to the basic fee
3. 2-Day Evaluation - U.S. $200 in addition to the basic fee
4. 5-Day Evaluation Report - U.S. $100 in addition to the basic fee
5. Re-evaluation - Re-evaluations based on documents not submitted with the original request are considered new evaluations and a second
payment of the basic fee $400 is required.
6. Extra evaluation reports - Additional original evaluation reports requested at the time of evaluation cost $20 each. Each evaluation report
requested after the evaluation has been completed costs $30 (evaluations may be available only within 3 years of the original date of issuance).
Please add $5 to the cost of each report that you wish to be mailed to you in a specially sealed JS&A envelope.
7. The applicants are responsible for any verification fees charged by their universities.
8. Do not send us any of your original academic credentials. If you do, you will be responsible for payment for their safe return (U.S. $45 for
a courier in the United States and U.S. $85 for a courier to other countries).

INFORMATION ABOUT EVALUATIONS

Sending your evaluation - Your evaluation will be sent electronically to the State Board of Nursing you specified in this application. If you would
like to send your evaluation to yourself or anyone else, select an extra evaluation report service and list the name and address in this application.
Method of Operation - To keep the cost of evaluations as low as possible, the evaluation service is conducted by mail. If there are questions
concerning an application, Josef Silny & Associates, Inc. will e-mail, write, or telephone the applicant. If the applicant requests a
personal interview, the charge will be U.S. $100 per half hour. Interviews are by appointment only.
Reassessment of Education Systems - Evaluations are based upon the best information and resources currently available to foreign credential
evaluators in the United States. Josef Silny & Associates, Inc. reserves the right to reassess educational systems as new and additional information
becomes available.
Satisfaction with Evaluations - JS&A generally follows the Placement Recommendations of The National Council on the Evaluation of Foreign
Educational Credentials. JS&A guarantees that all evaluations are prepared by highly qualified evaluators, but it cannot guarantee that the applicant
will agree with the evaluation. Any questions or concerns about evaluations must be submitted in writing.

02/23/2023
PE,RSONAL INTORMATION
If you have a U.S. Social Security N1unber, please list it: c",-'a.,, [Z [l
Malc Female

Full name
lfluttoy "t-tt Lttue. Kftt".<kwn.
Nfi ddle name&,Iaiden name

Street Addrcss f"o aox qg"1 Apartment #

(if applic.able)
Xrrntt KEilY4
City Statc Z,ip code Carmlr]'llf lrot Us.
(tnrn
)

Date ofbirth: 9e \or \>orr1' Courtuv of citizeriship (Efl/,1 Country of birth:

Mondl r Day/ Ye-ar

Telephone J25r+1\:tt0013lb Fax: E-mail \"!.t"rr.rrtrya..i @ 1rtC.,i ('Qo .-r

Arq codeand mbq Arq code .nd nlmbl5
-
T!1x of Professional Service Requested:

Basic Fees Additional Services -

El Licensing: Nursing (J.S. $400 basic fee) E Exlra Evaluation Report (J.S. S20 per report) How many?_
Rosh Fees E Extra Report in Sealed Envelope (tI.S. $25 per report) How many? _
fl 24-Hour Evaluation (U.S. $300 + basic fee) fl Secure R€tum ofOriginals U.S. $
E 2-Day Evaluation (U.S. $200 + basic fee) E Translation (quote p.ovidcd upon request) U.S. g
tr 5-Day Evaluation (U.S. $100 + basic fee) E other U.S. $
Please indicate forwhjch State Board ofNursing this evaluation has been r€quested for
f[on trnq Boa. {u.'ri.,
From whom did you lcarn ofJosefSihy & Associates,Inc. \r-rr\ S0LuTroll I Fltntrttetee
IIave you used JS&A services previously? Translation: Noy' Yes:_ Date:
Evaluation: Not/ Ycs:_ Date: _
Your el'aluation report will be sent electronically to the Stale Board of Nursing you specified and to )ou.
If you want your evaluation to be sent to an agency. employer, or yourself (at U. S. $20 per report), please list their na es and addresses below:

ACADEMIC HISTORY
Educational Institutions Attended (You must list all educational institutions you have attended. Begin with the first year of elementary school and
include any school you are now attending.)

oflnstitution
Year of
Name city, Country Diplomas or Certifi cates
From - Io Graduation

L 0 R.rm^RY SqftoDt I(t}\YA lT$ * ?.'u) C1.,1. 1 tc.ttt ' lcil

2. .ltr{YA ?roY - 2rrD+
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3. 0 o ri.t_ut, tsdlh l0r2 \ ptzrna
r
4. 11\ AO F YA Itro l8 - 2ot r ? .J.L\ll
5.
6.

I have read and understand the instruclions and conditions (including thal all f.es are non-refundahl€). I agree to the lenns slated hereh. I Lmderslald that *le
e\ralualion is advisory ard is not binding upon any agency or institution thal uses it. Further, in comideration ofthe paymed by th€ Luldersi$ed applicant, and the
mutual undertakings by the parties as slated in this Application ("Agr€ement"), the rmde8ign€d applicart reteases JS&,! its oflcers, direlto$, e1lrplolees, and
agents, from any liabiliry o. dmages resulting fromi (a) the use 1l) which I or any agency or institrdion puts the evaluation, and (b) for the loss of any origiml
documenll. In additiorL any litigalior arising out ofthis Agreement will be under Florida law, and venue will be in Miami-Dade County, Florida. The prevailing
party to any litigation arising out ofthis Agrc€ment is entided to reasonable attomeys fees and aI cosrs accrued during the litigarion.

SignaturE of thE applicaft Date rlrt lro1-3

Arplicationnus be signed by n d or dlenat sigurue (nd rtledl
B, signing yon sAree ro aI llm on fiis 02t23/1023