PLEASE ALLOW 3 TO 5 WORKING DAYS FOR COMPLETION OF EVALUATION

Name: ______________________________    SSN: ___________________

Send evaluation to one of the following:
    _____  Will pick up in Registrar's Office

    _____  Send to campus box number ______

    _____  Mail to home address (street, city, state, zip)

                    _________________________________________________

                    _________________________________________________

    _____  Other _________________________________________

Degree:   ___ Assoc. of Arts       ___ Bach. of Arts        ___ Bach. of Sci.

                 ___ Bach. Sci. Bus. Admin.    ___  Bach. Sci. Education

                 ___  Bach. Sci. Nursing           ___  Bach. Sci. Social Work

Expected Date of Graduation (month/year):  ____________    _________

Catalog year to follow for major: ________

Major(s) __________________________    __________________________

Minor(s) __________________________    __________________________

If Education (Middle Grades, pre 1998 certifications):

            Concentration(s) ____________________    ____________________

            Validation(s) _______________________    ____________________

Signature: _____________________________        Date: _______________
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Evaluation completed by __________________________    Date _________
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Print form and mail or bring to Registrar's Office, 200 Founders Hall