Educational Chronology: Complete the following section, use additional sheets, if necessary.
Name of School or Institution Date of Entrance Month/Year Date of Leaving Month/Year Name of diploma, certificate or degree, and date awarded(in your own language and exact English translation).
Primary Schools
Secondary Schools (For example: High School, Colegio, Lycee, Gymnasium, etc.)
College and or Universities (official name and country or location)
Other(including professional or vocational)
Job Training/Experience

Explain the purpose of the evaluation/service and add any comments or pertinent information.

Significant work or professional experience

Release Statement
   I affirm and certify that all documents and information provided are complete, true and correct to the best of my knowledge. False information on this application will render the evaluation or advisement null and void. Services provided by the CIE are not binding upon any agency or institution that receives them. The findings of the CIE may not necessarily agree with the opinion of the applicant.

    I release CIE from any liability for damages resulting from the use of the consulting service(s).

_______________________________________________    ___________________________
Signature    Date

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