REV: 08/09
University of Hawai‘i – Leeward Community College
Transcript Evaluation Request Form
This request is valid for one year from date of receipt. Submit this form only if you completed the following
My declared home institution is Leeward Community College I previously attended LCC and need my transcripts
I am currently enrolled in the UH system and paid tuition. evaluated to graduate THIS semester
I have requested all transcripts listed below to be sent to LCC.
Student ID Number or MyUH Portal Username: ________________________________________
Name: __________________________________________________________________________ Previous Names: ____________________________
Last First M.I.
Telephone: _____________________________________ UH Email Address: __________________________________________________________
Address: ___________________________________________________________________________________________________________________
Street Apt City State Zip Code
Have you previously had an evaluation done by LCC?
NO YES Year (approx): __________ Major: ______________________________________
Have you applied for Financial Aid and would like them to be notified when the evaluation is complete?
Official non-UH system transcripts, AP/CLEP exams, military transcripts, etc. must be sent directly from the originating
college/institution to Leeward Community College’s Admissions and Records Office. If a grade has changed or
you are currently
enrolled in courses that have not yet been graded, you must submit a new Transcript Evaluation Request Form and official transcript
after the (new) grade(s) is recorded. If you previously attended a college/university in the University of Hawai‘i system, official
transcripts need not be requested.
International transcripts-Transcripts from other countries must be in English or translated into English by the originating campus
or the U.S. Consulate. Translated course descriptions may also be required. It is highly recommended that you request course
descriptions along with the request for your academic transcript.
List transcripts that need to be evaluated:
College/University (CLEP/AP exams, military) Dates of Attendance (Mo/Yr) City & State/Country
__________________________________________ ___________ to___________ __________________________
__________________________________________ ___________ to___________ __________________________
__________________________________________ ___________ to___________ __________________________
__________________________________________ ___________ to___________ __________________________
__________________________________________ ___________ to___________ __________________________
The degree/certificate that I plan to earn at Leeward Community College is:
Associate in Arts Major: _____________________________
Associate in Applied Science Major: _____________________________
Associate in Science Major: _____________________________
Certificate of Achievement Major: _____________________________
Certificate of Completion Major: _____________________________ Specialization: __________________
Academic Subject Certificate Major: _____________________________
Certificate of Competence Major: _____________________________ Specialization: __________________
For prerequisite purposes only. I do not plan to earn a degree/certificate from Leeward Community College.
Do not
check this box if you are applying for financial aid or V.A. benefits.
Once your evaluation is complete, you will be notified via your UH e-mail address. You can then view your
transfer credits on your
unofficial transcript via your MyUH Portal.
Student’s Signature: __________________________________________________ Date: _________________________________
Official Use Only Completed on:
____________________ By: _____________________________ Student Notified on: _____________
Entered on:
____________________ By: _____________________________ FA Notified on: _________________