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GLOBE LANGUAGE SERVICES,
INC. EVALUATION SERVICE 319 BROADWAY, (212) 227-1994 FAX: (212)
693-1489 e-mail:
info@globelanguage.com www.globelanguage.com |
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APPLICATION FOR EDUCATIONAL CREDENTIALS EVALUATION
FOR IMMIGRATION PURPOSES
(See instructions below BEFORE filling out this form.)
1. Name………………………………………………………………………………………………………………………
(Family Name) (First Name) (Middle Name)
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2.
Address……………………………………………………………………………………………………………….…... …………………………………………………………………………………….…………………………………………. 3.
Where did you hear about us? …………………………………………………………………………………….…………………………………………. 4.
If you want this evaluation mailed to an attorney or another person, please
give name and address below: …………………………………………………………………………………….…………………………………………. |
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…………………………………………………………………………………….…………………………………………. |
5. Telephone Contact No: (……)……………………Fax
No. (……)……………………E-mail………………………..
6. Date of Birth………/………/……… 7. Male Female
(Month) (Day) (Year)
8. Country of Birth...........................……… Country of Studies..............................………………….....
9. EDUCATION: Please list the last two schools
you have attended. Give exact dates and diplomas
Institution Name |
Country |
Dates (from and to) |
Name of Diploma |
Graduation date |
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10. Position you are seeking in the
- Occupational Title(s)...............................................................................………....………..……….
- Code....................................................................................................................………………...
TYPE OF EVALUATIONPlease Select Type of Evaluation |
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Diploma/Degree Equivalent for Immigration |
($90.00) 3 Business Days or *5 Business Days
if we translate. |
24 Hour Rush ($100.00 additional) |
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Combined
Education/Professional Experience/Expert Opinion Evaluation |
($400.00) 5 Business Days |
24 Hour
Rush ($175.00 additional) |
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Industry Standard Letters |
($400.00) 10 Business Days |
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● Globe will also officially translate, certify, and notarize your documents
for a moderate fee. Check translation prices at www.globelanguage.com
MAILING SERVICEPlease Select |
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PRIORITY
MAIL ($10.00) INTERNATIONAL EXPRESS MAIL ($45.00) Stamped Envelope Enclosed |
INTERNATIONAL
($10.00) EXPRESS
MAIL ($30.00) |
CREDIT CARD AUTHORIZATION
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Payment must be made by US
Money Order or Credit Card. (No Personal Checks/No Debit Cards). (No 3rd Party Credit Cards Accepted) |
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AUTHORIZED AMOUNT $___________ |
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TYPE
OF CARD: Visa / MasterCard / Discover /
American Express
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CARD
NUMBER _______________________________ |
CARD
EXPIRATION DATE ____/____ |
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BILLING
ADDRESS
__________________________________________________________________ |
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CARDHOLDER
NAME ______________________ CARDHOLDER SIGNATURE _____________________ |
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CREDIT
CARD CODE# __________________________________________________________________
(3 number located on back of card or 4 numbers on AMEX on the front of
the card) |
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I hereby affirm that: a) the information provided by me is correct; b) I agree to the terms herein stated; c) I understand this report is advisory and is not binding on anyone who uses it; d) I release Globe Language Services, Inc. from any liability for damages resulting from the use to which I or any agency or institution puts the evaluation report.
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(Signature) (Name,
Printed) (Date)
Return
the completed application to Globe Language Services, Inc. with the following:
a)
NOTARIZED PHOTOCOPIES OF ALL ORIGINAL ACADEMIC RECORDS IN ORIGINAL
LANGUAGE (See instructions below for details).
b)
c)
STAMPED, SELF-ADDRESSED ENVELOPE.