MJC Evaluations Oce 435 College Avenue, Student Services Bldg. 1st Floor Modesto CA 95350 Phone (209)575-6605 Fax (209)575-6695
Student ID: w Today’s Date:
Student Information (Please list your legal name):
Last Name: First Name: MI:
Phone:
College Where Course Was Taken:
Course Title, Number:
Number of Course Units:
Purpose of Equivalency:
Student Please Read:
• Please complete the following information.
• Attach a course description of the course you are requesting equivalency for and any other information you
have about the course (i.e. syllabus, course outline, etc.)
• Return this form to the appropriate Division for review.
• If you would like an equivalency for more than one class, each class must be listed on a separate form.
• Any questions regarding this form, please contact the Evaluations Oce.
Course Equivalency Request
FOR DIVISION USE ONLY
Upon review of the above listed course and any attached documentation, the
division has deemed this course:
Equivalent to Modesto Junior College Course:
NOT Equivalent to any course oered at Modesto Junior College.
Justication for decision/note:
Name of Instructor (Please Print): Extension:
Signature of Instructor: Date:
Signature of Division Dean: Date:
Please return completed form to the Evaluations Oce, Student Services Building, Room 110
Course Equivalency Request Form_7/15/15_LY
FOR EVALUATIONS USE ONLY
Record Adjusted: Student Notied:
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