FACS

Foreign Academic Credentials Service, Inc. P.O. Box 400 Glen Carbon, IL 62034
Office Use Only

REQUEST FOR ADVISORY EVALUTION OF FOREIGN CREDENTIALS

Note: Please read, complete and return this form with your educational credentials and fee. Please type or print neatly.

PERSONAL INFORMATION
Check One

Name: ______________________________________________________________________ Mr. Ms. Mrs.

Last/Family First/Given Middle/Maiden

Mailing Address: _______________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ E-mail Address: ________________________________________________________________________________

Note: Please add our e-mail address facs@aol.com to your address book to avoid our messages being marked as Spam.

Telephone: ______________________________________ Fax: __________________________________________ Date of Birth: ____________________________________ Country of Birth: _______________________________
month/date/year

Country (s) of Credential: ________________________________________________________________________ Have you ever applied to FACS? Yes No If yes, indicate year: _____________________________________ Indicate if you have already passed in full the Uniform CPA Examination in: ________________________________
State Testing Window Quarter Year

Indicate board(s) of accountancy to which the advisory evaluation is to be mailed*: ____________________________________________ ____________________________________________ ______________________________________________ ______________________________________________

* The state board(s) of accountancy to which the advisory evaluation is to be mailed is REQUIRED.

Indicate amount of fees attached (see page 4): _______________________________________________________

PROCEDURES AND CONDITIONS

Each applicants academic credentials will be evaluated to assess whether his or her educational preparation, in the opinion of FACS, fulfills the education requirement to sit for the Uniform CPA Examination in the state or jurisdiction to which the application is being made. The board of each state or other jurisdiction will consider the FACS evaluation as advisory and reserves the right to make final determination as to the eligibility of the applicant. FACS reviews only the academic experience of an applicant and does not provide advisory recommendations concerning the reciprocity of foreign earned professional qualifications and work experience. E-mail confirmation of receipt of your evaluation request will be sent if a correct e-mail address is provided. Any educational credential submitted after an evaluation has been completed will require a new evaluation and a new fee payment. Requests to change an evaluation from one board to another board (for example, Washington to Florida) will require a new fee payment for a new evaluation. All information requested must be provided within a one-year period, at which time records will be discarded and the evaluation process will have to be initiated again. FACS retains completed evaluation records for five (5) years from the year of evaluation.

EDUCATIONAL PREPARATION
Report every school, college, and university you have attended or are now attending. Give exact dates of attendance. Elementary/Primary Schools Name and Location (city, country) Date of Entrance Date of Leaving Name of Diploma, Degree, or Certificate (in original
language and exact English translation)

Month

Year

Month

Year

Secondary Schools (High School, Colegio, Liceo, Lycee, Gymnasium, etc.)

Colleges, Universities, Higher Institutes and other university-level schools

Other Post-secondary schools (such as professional or vocational)

Earned professional qualifications (e.g., Chartered Accountant, Certified General Accountant, etc.)

DOCUMENTS REQUIRED
Educational credentials must include official transcripts of records from all universities and other institutions of higher education attended, including those in the United States. Such records must report all courses (subjects) by title completed, grades earned, and degrees, diplomas, and certificates awarded. In those countries (e.g. India, Pakistan, United Kingdom) where universities do not issue course by course transcripts as in the United States, applicants must present all official examination results for each year of study, including the final year, specifying each course (subject) by title taken and marks achieved; and certification of degree or diploma awarded. The issuing institution must officially certify those examination results. Applicants who have attended European universities and other higher education institutions (for example, in Germany, Switzerland, France, Netherlands, Sweden, Poland, Russia, etc.) must request those institutions to provide FACS with an official report of all courses (subjects) by title completed toward the diploma that includes the number of instructional/lecture/seminar hours offered weekly in each course (subject) during each academic semester or year. Official copies of diplomas earned and all examination results in each course (subject) must be provided. Academic records from European Schools that participate in the European Credit Transfer and Accumulation System should report ECTS credits for each course. Applicants who have attended colleges or universities in the Peoples Republic of China must request those institutions to provide FACS with transcripts of academic record that reports the credit value and/or class hours for each course (subject) must be provided. Applicants who have received the General Certificate of Education in Advanced Level subjects or who have passed the Hong Kong Advanced Level Examination should submit official copies of these certificates or examination results that report their Advanced level subjects by title. Applicants who have earned professional qualifications in accounting in another country should submit relevant supporting documents, including complete and official examination results and qualifications granted. FACS recommends that descriptions of courses in accounting and business-related subjects be provided. If this documentation is not in the English language, it must be accompanied by an official English language translation. Official English language translations must accompany official copies of records that are in another language. Official records including diplomas, in the original language must be submitted with the English language translations. FACS may request the applicant to provide additional or other records and/or to complete supplemental forms describing his or her educational preparation in order to formulate an accurate advisory evaluation. FACS will also, when necessary, contact an institution in another country or in the United States for further information about an applicants credentials including verification of authenticity. In the event that FACS determines that the academic credentials submitted for evaluation have in any way been altered, tampered with, or forged, no evaluation will be prepared. All fees will be forfeited and appropriate notification will be issued.

SERVICES AND FEES

Fees must be paid in advance and are non-refundable one the evaluation process has been initiated. 1. Evaluation Fee $200/each state (Colorado, Connecticut*, Michigan**, Nebraska, Nevada, $__________ New Hampshire, Pennsylvania, Vermont and Wisconsin) $150/each state (Florida, Maryland, Mississippi, New Mexico, $__________ North Carolina, North Dakota, South Carolina and Washington) $100/each state (other states) $__________ * This is for Connecticut State Board of Accountancy license application. ** This is for Michigan State Board of Accountancy license application.

OPTIONAL SERVICES
2. Extra Official Copies (one copy to state board and/or coordinator, and one copy to applicant included in evaluation fee.) __________ x $20.00/each extra copy $__________
(number)

3.

Mailing Services (1st class mail and airmail will be used unless otherwise indicated, mail to the board and/or coordinator included
in evaluation fee. Please note that if original documents are to be returned, a mailing service must be selected.)

4.

Overnight Courier (domestic) Overnight Courier (international) U.S.P.S. Priority Mail (domestic only) Certified Mail (domestic) Registered Mail (international)

($20.00/address) ($40.00/address) ($5.00/address) ($5.00/address) ($15.00/address)

$__________ $__________ $__________ $__________ $__________

Facsimile Transmission of Evaluation (must provide accurate fax number) Domestic ($5.00/transmission) International ($10.00/transmission)

$__________ $__________ $__________

TOTAL FEES
The above fee schedule is subject to change.

Please make check or money order payable in US funds to FACS, Inc. Credit cards are not accepted. (Note, payment from outside US must be in US Dollars and must be issued from a bank that has branches in the US and includes routing numbers.)

I certify that all of the information provided on this form is accurate and complete; and I have read and accept the procedures and conditions described on this form.

________________________________________
Applicants Signature

________________________________________
Date

Rev. 06/11