Consultancy on International Education
P.O. Box 2792
Champaign, IL 61825-2792


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(Please type or print legibly)

Full Name: ________________________________________________________________________________________
Mr. or Ms. Last (Family) First Middle or Maiden
(Full name will be used in the evaluation report.)

Mailing Address: _____________________________________________________________________________

Telephone Numbers: ________________________________________________________________________________
Home Number Work Number

E-mail address: ____________________________________________________________________________

Date and place or birth:______________________________________________________________________________________
Month Day Year City Country

Country of Citizenship:   ___________________________ Visa Type or Status:   _____________________

Type of service and fee schedule. Circle the service(s) requested. Attach the fee(s).

A. General Evaluation (Credits are not included.) (U.S. $95.00)
B. Itemized Evaluation (course-by-course & credits) (U.S. $145.00)*
a. With grades calculation, add $80.00
b. For up to 2 degrees or institutions, $145.00*
For more than 2 degrees or institutions attended, add $60.00
(to the standard fee) for each additional degree or institution attended.
C. Credential Reconstruction (U.S. $235.00)
D. Education/Job Equivalency Evaluation   (U.S. $310.00)
E. Ph.D. Equivalency Evaluation   (U.S. $370.00)
F. Rush Service 1-2 days
3-5 days
(U.S. $120.00 *plus express mailing charges)
(U.S. $90.00 *plus express mailing charges)
G. Extra Copies   (U.S. $20.00 *per copy)

Expect a 2-week delay if paying by personal check. Checks need to clear the bank before service can be rendered.
Money order is the recommended form of payment. Credit card payments are not accepted.

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