Office of Transcript Evaluation Services, 4000 Lancaster Drive NE, Building 2, Room 200,Salem, OR
Mailing Address: PO Box 14007, Salem, OR 97309-7070
Phone: 503.399.6588 Fax:503.399.3918 Email: evaluation@chemeketa.edu
Chemeketa Community College is an equal opportunity/affirmative action employer and educational institution. To request this publication in an
al
ternative format, please call 503.399.5192.
3/28/2018 s:\registrar\forms\request for evaluation and transfer of previous credits.docx chemeketa.edu
Request for Evaluation and Transfer of Previous Credits
U
se this form to request an evaluation of previous credits from prior institution(s). Courses are evaluated based on best fit for program(s) listed. Once
the evaluation is complete an email will be sent to your MyChemeketa account.
1. Complete and submit this form to one of the following: Enrollment Center, Transcript Evaluation Window 13 in Bldg. 2, fax, or email t
o
ev
aluation@chemeketa.edu
a. Transcripts must be official and from a regionally accredited institution to be evaluated. We do not accept faxed transcripts.
b. Evaluations are processed once all transcripts listed on the form have been received.
c. Turnaround time is dependent on the volume of requests.
Student ID (K#): Date of Birth (mm/dd/yyyy):__________________
Name (as it appears in our records): __________________________________________________________________
Mailing Address:__________________________________________________________________________________
Street City State Zip
Phone Number with Area Code: Cell Phone: _______________________ Home Phone: ________________________
Previous Name(s) Used: __________________________________________________________________
Check Only if Applicable:
I am attending Chemeketa under Veteran Affairs (VA) Benefits
(Submit this form when enrolling for your first term at Chemeketa. All prior credit needs to be evaluated and reported by the end of your third
I have applied for a degree or certificate at Chemeketa
(Submit this form and your Application for Graduation by the end of the fourth week of the term prior to the expected term of
I am applying for a limited enrollment program at Chemeketa
(All Chemeketa programs are listed on the second page of this form. Limited enrollment programs are designated with an *)
Chemeketa is not required to accept all credits from other institutions. Submitted transcripts will not be returned or
photocopied.
Schools Providing Transcripts for Evaluation:
School: School:
S
chool: School:
I have requested official transcripts be sent to Chemeketa
Please use transcripts that are currently on file from a previous evaluation for a different program
DEGREE OR CERTIFICATE NAME:
S
tudent Signature: _________________________________________________________Date:___________________
K
click to sign
signature
click to edit
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