Standard Evaluation Report Application Form For Institutions
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1
2STANDARD EVALUATION REPORT
APPLICATION FORM FOR INSTITUTIONS
Educational Credential Evaluators, Inc. Standard Evaluation Reports are based on
documentation requirements stated for each country on the ECE® website:
https://
6/15
STUDENT INFORMATION & EDUCATIONAL HISTORY
Name (Last, First, Middle):
Name on educational document(s):
Purpose of report - Circle one or more: Further Education / Employment / Professional Licensure / Immigration / Military
Circle one: Male / Female
Date of Birth (mm/dd/yyyy):
Does this student have a previous ECE® report? Circle one: Yes / No / Unknown
ECE® Reference Number (if known):
List all institutions student attended, beginning with high school
State Yes or No for Each Credential
Did the
Documents
Do you want this
Dates of
Country
School
Name of Degree / Program
student
being mailed
credential
enrollment
graduate?
separately?
evaluated?
REPORT TYPE & RUSH SERVICE
FEE
: Select one type of report and optional rush service
$____
___ General ($85) ___ General with Grade Average ($110) ___ Course-by-Course/CBC ($160) ___ High School & University Level CBC ($195)
___ 1 Business Day Rush ($200): available for General
$____
___ 5 Business Day Rush ($80)
___12 Business Day Rush ($50)
and General with Grade Average reports only
REPORT RECIPIENT
ELECTRONIC DELIVERY
FREE
Institution
___ Dispatch®: To sign up for this service, see
https://
Institution Address
PAPER DELIVERY - select one
Check here if original documents
Contact Name
are returned to this contact.
___ U.S. Priority Mail - 2 to 3 days ($10)
$_____
Address to return original
___ U.S. Courier Service - 1 day ($35)
documents, if different
___ International Courier Service ($60)
Email & Phone
State number of additional copies to this
Report price includes one copy sent to the institution named above. Additional report copies to this
$ _____
address may be added for $25 each.
address _____ x $25
ADDITIONAL REPORT RECIPIENT :
$25 fee for each additional report recipient (use additional sheets if necessary)
$ _____
ELECTRONIC DELIVERY
Institution
FREE
___ Dispatch®: To sign up for this service, see
https://
Address
PAPER DELIVERY - select one
___ U.S. Priority Mail - 2 to 3 days ($10)
Contact Name
$_____
___ U.S. Courier Service - 1 day ($35)
Email & Phone
___ International Courier Service ($60)
PAYMENT
: If no invoice code, provide credit card payment information
ECE® invoice code (if assigned):
Visa or MasterCard No.:
3-digit security code:
Exp. Date:
TOTAL
Name on credit card
$_____
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