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Name
Please provide all the information requested below

Last Name:

First Name:

Middle Name:

Other Names used:

________________________________________________

Contact Information
Include your direct (immediate) contact information

Street:

City:

State:

Zip Code:

Country:

Telephone Number:

Fax Number:

Cellular Number:

E-mail Address:

________________________________________________

Personal Information

Birth Date:

Month:
Day:
Year:

Sex:

Products and Services:

check the type of evaluation
needed

Type of Credential Evaluation Report	Price
High School Diploma Credential Evaluation	$150
General Comparability Credential Evaluation Report: Certificate, Associate, Bachelor’s, Master’s, PhD	$150
Course-by-Course Credential Evaluation Report: Certificate, Associate, Bachelor’s, Master, PhD	$250
Evaluation of Education and Work Experience	$350

Additional Services:

Check the type of Additional Services needed

	Price
Every other Diploma/Certificate General Comparability Credential Evaluation Report: Certificate, Associate, Bachelor’s, Master’s, PhD	$50
Every other Diploma/Certificate Course-by-Course Credential Evaluation Report: Certificate, Associate, Bachelor’s, Master, PhD	$100
1-Day Rush Processing	$75
Next Day Air Express Delivery	$40
Extra Copy of the Evaluation Report	$30

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Educational Institution List All Educational Institutions Attended (From High/Secondary school). Specify which one is providing the Major Credentials you wish to have evaluated. Specify which one is providing the Other Credentials you wish to have evaluated.
Name	Name of Educational Institution(s) Attended
Country:
Diploma/Certificate:	Diploma/Certificate Earned (if any)
Month/Year Entered:
Month/Year Completed:

________________________________________________

Credit Card Information

Visa: Master Card: Discover: American Express:

Credit Card Number:

Expiration Date:

Security Code:

Last 3 digits on the back of the card

Billing Zip Code:

Terms of Service

I certify that all of the information provided on this application form is true and correct to the best of my knowledge. I certify that I have read all the information provided on this application form and I agree with all the terms and conditions. I understand that evaluation reports prepared by Fikrat Consulting, Inc. are advisory, and are not binding on any institution, organization, or agency which may use them. I release Fikrat Consulting, Inc. from any liability for damages resulting from the use of an evaluation report by me or any third party. I release Fikrat Consulting, Inc. from any liability for damage to or loss of any documents submitted. I understand that the information provided by Fikrat Consulting, Inc on the application and instructions is subject to change without notice. I understand that if false information or forged, altered, or falsified documents are submitted to Fikrat Consulting, Inc. at any time, no evaluation report will be prepared, no refund will be made, the designees for copies of the report will be notified, and the information will be shared with academic institutions, government agencies, professional organizations and other evaluation services. This application creates a contract between Fikrat Consulting, Inc. and the person who has signed the application. If the signer is not the person whose educational credentials are being submitted for evaluation, the act of signing certifies that the signer is acting on behalf of the person whose educational credentials are involved, and has the authority to do so.

By clicking "I Agree" you agree and consent to Fikrat Consulting, Inc. Terms of Service.