PREREQUISITE VERIFICATION FORM
Instructions: Complete steps 1-4. Use one request form per course. Only proper documentation
with college name, final grade and catalog course description will be accepted.
DATE SUBMITTED: _
STEP 1 STUDENT INFORMATION
EVC Student ID:
Last Name: First Name: Middle Initial:
Phone Number: Email:
EVERGREEN VALLEY COLLEGE COURSE INFORMATION
List EVC course you are requesting to take.
COURSE #: 71
TITLE: Calculus I
DEPT: COURSE #: TITLE:
PROOF OF PREREQUISITE COURSEWORK COMPLETED
List EVC Prerequisite(s) Needed
List Course(s) taken at another college that meets
Check appropriate box of the document(s) you are submitting.
Official or unofficial college transcript with final grade and catalog course description
SUBMIT FOR REVIEW
Attach appropriate document(s) and course description(s) to this form by email.
A. IN PERSON:
Not currently available
Send an electronic copy of this form (PDF), along
with transcript and course description to:
with subject line
Prerequisite Verification Form
REQUEST CANNOT BE PROCESSED UNTIL ALL DOCUMENTS ARE RECEIVED.
YOU WILL BE NOTIFIED BY EMAIL WITHIN 5 BUSINESS DAYS
FOR OFFICE USE ONLY:
Date received by email: APPROVED DENIED COUNSELOR’S NAME:
DATE ENTERED IN WebUI (NCWS): Date Student Notified: