Date ______________________ ECC ID # or Social Security #_________________________
Name _________________________________________________________________________
(Last) (First) (M.)
List all FORMER names __________________________________________________________
Degree/Certificate goal Please check the appropriate box.
(You must answer this section in order to be evaluated. Check ECC Catalog for details.)
Associate in Science (transfer) Associate in Arts (transfer)
Associate in Liberal Studies Associate in Engineering Science
Associate in Fine Arts (Music)  Associate in Fine Arts (Visual Arts)
Associate of Applied Science in ________________________________________________
(Please indicate area of study)
Vocational Specialist Certificate in ______________________________________________
(Please indicate area of study)
Basic Vocational Specialist Certificate in _________________________________________
(Please indicate area of study)
List previous colleges/military experience that you want evaluated:
1. ____________________________________________________________State:_________
2. ____________________________________________________________State:_________
3. ____________________________________________________________State:_________
4. ____________________________________________________________State:_________
5. ____________________________________________________________State:_________
Current Address ______________________________________________________________
(City) (State) (Zip)
Telephone ______________________________________________________________
(Day Phone) (Evening Phone)
If you have difficulty submitting this form by email, you can mail, save the PDF to your computer and attach to an
email to, fax to 847-214-7484, or drop off in the Records office (Bldg B).
Note: It is the student’s responsibility to request
official transcripts for ALL colleges, universities
or the military and contact records at 847-214-7386
to confirm all transcripts have been received prior to
requesting the evaluation.
Please allow 2 weeks for processing. Notification
that your evaluation results are available will be
sent to your email address.