Transcript Evaluation Request - Lorain County Community College Page 2
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Lorain County Community College
1005 North Abbe Road Elyria, Ohio 44035
(440)366-4074 1-800-995-5222, Ext. 4074
TRANSCRIPT EVALUATION REQUEST
Request for Evaluation of College Level Transcript(s) and/or Military Records
Check the statement that applies to you
This is my first submission of college and/or military transcripts for evaluation.
or I have had other college and/or military transcripts previously evaluated by LCCC.
Full Legal Name
(Last)
(First)
(Middle Initial)
(Maiden Name and previous others)
Address
LCCC Student Number
(Number)
(Street)
(Apt.)
(not your Social Security Number)
(City)
(State)
(Zip Code)
Social Security Number
(Area Code)
(Telephone Number)
Have you served in the United States military? NO
YES
If yes, attach a certified copy of your DD214 or Notice of Basic Eligibility for Physical Education Credits.
*Program of Study at Lorain County Community College
*(must declare if receiving Veterans Benefits or entering any program requiring a GPA audit)
OFFICE USE ONLY
List College(s) and/or Military Record(s) to be Evaluated
Date(s) of
Date Transcript
Transcript
Received
Attached
Attendance
(DO NOT USE ABBREVIATIONS)
Verified In Card File
The Official Transcript(s) from the above named institution(s) has (have)
been requested.
By
Date
NO
YES How long ago?
By
Date
I am requesting that the above college transcript(s) and/or military record(s) be
By
Date
evaluated for possible transfer of credit to Lorain County Community College.
Legal
Expected Enrollment
Year and Term
Signature
Date
Request Received By
This request is valid for three (3) months from the date
Date Request
of receipt by the Transfer Center.
Received
NLK: REV. 10/08
ADMSNS6.DOC
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