Directions: Please complete the Personal Information” portion of this form and submit it with a copy of your transcripts from
EACH college/university attended. Be sure to include the NAME of institution if not noted on transcript. Even if all courses are
listed on one transcript, we still require a copy of your transcript from EACH college/university attended.
Personal Information
Name: __________________________________________________________________________________________________________________________
Last Name First Name M.I.
UHID/Use
rname (if applicable): ____________________________________
I would like this evaluation returned to me via (please check box below to indicate preference):
Fax: ________________
______________________________ Email: ____________________________________________________
List other n
ame(s) used on documents: _____________________________________________________
List all transcript institution(s):
1. ________________________________________________________ 2. ________________________________________________________
3. ________________________________________________________ 4. ________________________________________________________
5. ________________________________________________________ 6. ________________________________________________________
NOTE:
This service is a preliminary evaluation to determine course equivalencies for County of Hawaii Fire Fighter Recruit applicants.
Please note that this unofficial evaluation is subject to final approval by the Registrar and is only intended as a guideline for the
County of Hawaii. For an official transcript evaluation, students must complete a Transcript Evaluation Request Form and have
their official transcripts sent directly to the Kekaulike Information and Service Center.
(For office
use only)
Evaluation:
EMS Prerequisite
Coursework
Course Alpha Cr/Grade
Term of
Completion
Where Completed
(i.e., Institution Name)
Approved
(Y/N)
ENG 100 Composition I (3)
HLTH 125 Survey of Medical
Terminology (1)
Application Summary: For office use only
Date Received: _____________________ Counselor’s Initials: _________________
Rev. 2/2/15
Emergency Medical Service
Kapi`olani C
ommunity College
Request for Transcript Evaluation for County of Hawaii Fire Fighter Recruit
Return your request via fax to:
The Emergency Medical Services D
epartment, Kapi‘olani Community College
Fax: 808-734-9126
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