IICUS.COM: Online Application

Online Application Form

Applicants must provide original and photocopies of the required documents accompanied by English translations and the appropriate fees. All translations must be certified. Please send all the required documents to IICUS 3550 Stevens Creek Blvd,. Suite #310 San Jose, CA 95117

1: To submit online application form please click here Online application form

2: To Fill out & Print application form please click here Fill out and Print application
3: To Print & Fill out application form please click here Print & Fill out application form

After filling the details click on the SUBMIT button.
*indicates required fields

*indicates required fields

*1:First Name:

*Middle Name:

*Last Name:

2: Gender:

Male
Female

3: Date of Birth:

4: Country of Birth:

5: Country of Citizenship:

*6: Current Mailing Address:

*7: Telephone:

8: PIN (if any) Personal Identification Number:

*9: Email Address:

10: Evaluation Request:

General Academic Work
Doctoral Work
Other

11: Type of Evaluation Requested:

Summary Report
Course Analysis-No Clinical
Course Analysis-With Clinical

Do you need a rushed evaluation?:

Yes
No

If your answer is yes, please check one::

24 Hours
3 Working Days
5 Working Days
10 Working Days
15 Working Days

Do you need extra official copy:

Yes
No

If Yes, how many:

This evaluation is intended for:

Employer
College or University Admission
Other: (Please Specify?_____________________

Where do you want the evaluation to be mailed?:

Original and Copy to You
Original to the intended agency and copy to you

Please give the complete name and address /school:

List below all schools, colleges and universities:

School Name :
Dates Enrolled :
Units Completed :
Degree Earned :
Date Expected :

School Name:

Dates Enrolled:

Units Completed:

Degree Earned:

Date Expected:

How did you hear about IIC?:

Friends
Brochure
A University or College
Language Schools
Internet

Other (Please Specify)::

*Term and Conditons:

*Signature:

Agreed
Authorized

After filling the details click on the SUBMIT button.
I have read and understand the terms and conditions described about this evaluation by IIC.

Please remember to enclose all documents with your application. Including: certificate(s), diploma(s), transcript(s), mark sheets, grade reports, course syllabus translations and fees. INCOMPLETE FILES MAY DELAY YOUR EVALUATION.

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