Fillable Form XXX-XX- Social Security#: last 4 digits Date (Western Technical College)

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Form XXX-XX- Social Security#: last 4 digits Date (Western Technical College)

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File type: PDF

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Military Credit Evaluation
Form
Evaluation completed upon admission acceptance at Western Technical College
Last Name:
First Name:
M.I.:
Previous/Maiden Name:
Student ID#:
Social Security#: last 4 digits
Date of Birth: mm/dd/yyyy
Phone#:
Street Address:
State:
Zip:
Email:
Program of Study to be Evaluated:
Semester Admitted:
Military Branch:
Years Served:
DD214: On File Pending
Please list all post-secondary colleges/universities from which all official transcripts have been requested.
College/University Name:
College/University Name:
College/University Name:
College/University Name:
Joint Services Transcript (JST): Requested On File
Http://jst.doded.mil
Airforce Transcript (AU or CCAF): Requested On File
Http://airuniversity.af.edu/academic-affairs/registrar
Please send Evaluation form and transcripts to:
Paula Speropulos
Western Technical College
Veteran Military Center, ARC122
400 7
th
Street N; La Crosse, WI 54601
Phone: 608-789-4767; Email: speropulosp@westerntc.edu; Fax: 608-785-9159
Electronic Student Signature (Please type your First and Last Name)
I understand that checking this box constitutes a legal signature confirming truthfulness of the information provided.
Notes:
XXX-XX-
Updated: 01/14/2019
Date:
mm/dd/yyyy
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Form XXX-XX- Social Security: last 4 digits Date (Western Technical College)

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Completed 10 October 2020

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