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Please check the
appropriate box below:
TRANSLATION [ ]
EVALUATION [ ]
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*Processed within 3 business
days
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File Name:..............................................................................................................
(indicated in the upper right-hand corner or at the bottom of the document)
Please note that, All
duplicates are available for evaluations and translations completed within
the last ten years. Copy requests are processed within three
business days. Duplicates of evaluations and translations are $40.00 for
the first copy and $20.00 for each additional copy. Same-day
service is available $55.00 for the first copy and $20.00 for
each additional copy.
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FOR EVALUATION:
Social Security # ... ... ...- ... ... - ... ... ... ...
(Required for NY City Jobs)
[ ] Diploma/Degree Equivalent [ ] Course-by-Course
Evaluation
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FOR TRANSLATIONS:
(Please indicate type of document)
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[ ]Secondary School Document
[ ]Higher Education Diploma [ ]Transcript
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[ ]Birth
Certificate [ ]Marriage
Certificate [ ]Divorce
Certificate
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[ ]Work Experience
Letter [
]Medical Certificate [ ]Other
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1. Name of Applicant:
............................................................................................
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(as they appear on the
document) (Last)
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(First)
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(Middle)
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2. Country of studies
...................................................................
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3. Address
..............................................................................................................
................................................................................................................................
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4. Telephone Contact No:
(.....)............................Fax: (.....)..................................
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5. E-mail address
.......................................................................
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6. Date of initial evaluation/translation
...............................
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7. Number of duplicates you are now requesting
......................
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8. If you want this duplicate mailed to an agency or
another person, please give name and address below:
...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
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9. Please select:
Self-Enclosed Envelope Priority Mail ($10) Express
Mail ($30)
If you dont have all of the above information about your file, please send
us as much information as you have. We will attempt to fulfill your request.
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Each duplicate translation/evaluation costs $40.00 for the first copy. Any
extra copies in addition to the first are $20.00. Payment must be by U.S.
money order or credit card (no personal checks or debit cards, please),
including the pertinent information on this form.
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I am paying $
____________________
(No 3rd Party Credit Cards Accepted)
Type of Card: Visa /
MasterCard /
Discover /
American Express
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Cardholders Name
.
..
Card No.
.................................
Expiration Date: (Month) ....../ (Year)
.......
Credit Card Code#
..
(3
number located on back of card or 4 numbers on AMEX no the front of the card)
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Cardholders Billing
Address..........................................................
.ZIP Code
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Cardholders
Signature..........................................
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