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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


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International Institute of California

(To print this page: Right-Click on the form and select "Print" from the pop-up menu)
PIN
Date

(Office use only)

 
 

3550 Stevens Creek Blvd., Suite #310 San Jose, CA, USA, 95117 Telephone (408) 249-1505 Fax (408) 249-3187 E-mail mulu@iicus.com

 
APPLICATION FORM
 
  
1. Applicant's Name (Last/Family)
    First
    Middle
2. Gender
Male Female
3. Date of Birth
Month Day Year
4. Country of Birth
5. Country of Citizenship
6. Current Mailing Address  
    Street Address
    Apt/Suite No.
    City
    State
     Zip Code
7. Telephone
Daytime: Evening:
     Fax:
     E-mail
8. PIN: (if any)
Personal Identification Number
    
 
9. Evaluation Request: (Check one please) (see brochure for description)
    
General Academic Work
 US Armed Forces 
Army,Navy,Air Force Coast Guard, Police Academy)
Doctoral Work
Other: (Please Specify)
10.Type of Evaluation Requested: (see description)
    (Check one please)
Summary Report(Mostly for High School Graduates)



  Course by course Analysis (All Others)

Course by course Analysis (With clinical)
11. Do you need a rushed evaluation?
Yes
No
    If your answer is yes, please check one:
 
24 Hours
5 Working Days
3 Working Days
10 Working Days
15 Working Days
12. Do you need extra official copy:
Yes No If Yes, how many
13. This evaluation is intended for:  
    (Check one please)
Employer
College or University Admission
Other: (Please Specify)
14. Where do you want the evaluation to be mailed?  

    (Check one please)

Original and Copy to You
Original to the intended agency and copy to you
    Please give the complete name and address of the agency:
 
 
 

15. List below all schools, colleges and universities in chronological order starting from primary school. 

School Name

Dates Enrolled
MM/YYYY

Units Completed

Degree Earned

Date Expected
MM/YYYY

 
(Attach additional pages if needed)
 
16. How did you hear about IIC?
Friends Brochure A University or College Language Schools Internet
Other (Please Specify):
 
I have read and understand the terms and conditions described about this evaluation by IIC.
 
Name Signature Date
 
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.
 

PLEASE MAIL TO

International Institute of California
3550 Stevens Creek Boulevard, Suite #310
San Jose, California - 95117
Telephone: (408) 249-1505 Fax: (408) 249-3187
E-mail: info@iicus.com
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IICUS
Tel:408-249-1505
Fax: 408-249-3187
Email:info@iicus.com
Member of
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NAFSA:Association of International Educators

 
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