Microsoft Word - Prerequisite Verification Request (Updated, 2021-06-22)

PrerequisiteVerificationRequest - Fillable(Updated,2024‐06‐20)

Createdby:V.Nazarov,24June2021

PrerequisiteVerificationRequest

Instructions: Completesteps1–4.Useonerequestformpercourse.Becertaintoincludeproperdocumentationwith

schoolname,finalgrade, syllabi, andcoursedescription.

DateSubmitted:

STEP1—StudentInformation

StudentID: PhoneNumber:

LastName: FirstName: MiddleInitial:

Email:

STEP2—EvergreenValleyCollegeCourseInformation

Listthecourseforwhichyouarerequestingprerequisiteverification.

Dept.: Course#: Title:

Example:

Dept.: Math Course#: 071 Title: CalculusIWithAnalyticGeometry

STEP3—ProofofPrerequisiteCourseworkCompleted

ListEVCPrerequisite(s)Needed(oneperline) ListCourse(s)TakenThatSatisfythePrerequisite(s)

1.

2.

3.

Checkappropriateboxforthedocumentationyouaresubmitting:

Requested Documents: Transcripts(official preferred,butunofficial accepted)showingcourseandfinalgrade; course

description; course syllabus, if available; and AP test scores, if applicable.

Other(explain):

STEP4—SubmitforReview to Academic Divisions

Attachappropriatedocument(s)andcoursedescription(s)tothisformpriortosubmittingit.

Requestswillnotbeprocesseduntilalldocumentationisreceived.

Youwillbenotifiedregardingtheresultofyourrequestbyemailwithin3weeks.

ForOfficeUseOnly:

Approved Denied Evaluator:



Name Date

VerificationenteredintoColleagueUI(NCWS)by/on:



Name Date

Comments:

Routing: Originaltorele

vantDivisionDean.

(NOTE: for NURS 119 & 120 requests, send to