COUNSELOR/EVALUATOR NAME:
Last updated 11/30/2015
PREREQUISITE VERIFICATION FORM
Counseling Support | 5055 Santa Teresa Blvd. | Gilroy, CA 95020
DIRECTIONS: Complete this form and indicate which course(s) you are seeking approval. Incomplete or unsigned forms will be
automatically denied. Once this form and all supporting documents are submitted, Gavilan College will notify you within 3 business
days via phone and or email regarding approval or denial of the course prerequisite verification.
Registration Term: ☐ Fall ☐ Spring ☐ Summer 20_____
STEP 1: Student Information
Student Name: _______________________________________________ Student ID #: G00________________________
Phone #: (______) ______ - ___________ Gavilan College Email: ____________________________________@my.gavilan.edu
Check the option you are using to verify the prerequisite:
☐ Coursework taken at another U.S. College/Institution: Complete Step 3A
ATTACH A TRANSCRIPT SHOWING A GRADE OF “C” OR BETTER AND COURSE DESCRIPTION(S) AT THE TIME YOU TOOK
THE COURSE(S).
☐ AP test score of 3 or higher (Attach an AP Test Score Report from CollegeBoard): Complete Step 3B
☐ Assessment/Placement Exam (Assessment scores only valid for 2 years from date of exam): Complete Step 3B
STEP 3A: COURSEWORK Equivalency Chart
Course(s) I
want to take at
Gavilan College
Gavilan College
prerequisite
Institution where prerequisite was
completed
Course Number &
Course Title
at previous institution
OFFICE USE ONLY
(Approved/ Denied)
and
Staff Initials
STEP 3B: ASSESSMENT Equivalency Chart
Course(s) I
want to take at
Gavilan College
Gavilan College
prerequisite
Institution where assessment was
completed
Name of Assessment and
Year Completed
OFFICE USE ONLY
(Approved/ Denied)
and
Staff Initials
STEP 4: Submit for Review
Submit completed, signed form with all supporting documents attached to:
Counseling Support
OR Email: prereqs@gavilan.edu
Phone Number: (408) 840-3024 or (408 )782-4657
By completing this form, I acknowledge this is not an official evaluation of my external coursework; I understand I will not receive course credit. This
form is for the purpose of verifying a prerequisite to a class I plan to take at Gavilan College, as identified on this form. I have the course description
and believe the course work from the external institution meets the prerequisite criteria.
Student’s Signature: ______________________________________________________________ Date: ___________________
