Arizona International Credential Evaluators 18025 W Denton Ave Litchfield Park, AZ 85340 Phone: 602.773.1316 Email: info@iceinaz.com Web: www.iceinaz.comStudent's Last Name/Family Name* Student's First/Given Name* Street Address*Address 2 City* State Postal Code Daytime Phone Number*Fax NumberEmail Address* Student's Date of Birth* MM slash DD slash YYYY Gender*MaleFemaleCountry of Birth* Country of Education* Product NameServices* Document-by-Document Course-by-Course GPA Required Please use document evaluation for education prior to 9th grade, and course by course evaluation for education, which includes 9th grade and beyond.Optional Additional Fees 3 business day RUSH 1 business day RUSH Translation to conduct the evaluation International Express Mail Overnight Express Mail—USA Only Return Documents Priority Mail—USA Only Additional Copies Educational HistoryList all educational institutions attended. Write the name of each certificate or diploma in English and in the native language. Native language records must be accompanied by English translations for the documents you want evaluated. Please enclose address information for mailing of copies, if different from above.Primary SchoolName of Institution* Country* Dates of Attendance* Diploma/Certificate Awarded* Name and Email Address of contact at school* Secondary SchoolName of Institution Country Dates of Attendance Diploma/Certificate Awarded Year of Graduation Name and Email Address of contact at school Secondary SchoolCountry Dates of Attendance Diploma/Certificate Awarded Year of Graduation Name and Email Address of contact at school Additional Educational HistoryPlease provide information for any additional educational institutions.Additional InformationName of school that you are applying to:* What grade:* Name and Email of contact at school:*Name of Person Completing Application* Upload supporting documents, including native language records with English translations.Max. file size: 50 MB.Upload as many documents as needed. Please combine document in a .zip folder, if possible. If you cannot upload them, please email them to info@iceinaz.comCertification of the Applicant or ParentI certify that, to the best of my knowledge, all of the information provided in this application is complete and correct. I certify that I have submitted all required documents, including native language records with English translations. I authorize Arizona International Credential Evaluators (AZICE), LLC to verify all submitted educational credentials in order to conduct a thorough and professional credential evaluation. I understand that evaluation reports prepared by AZICE are ADVISORY, and are NOT binding to any agency, institution or organization that uses them. I understand there will be no refund except as outlined in this application. I release Arizona International Credential Evaluators (AZICE), LLC from any liability for damages incurred by me, my representative, or any third party, resulting from the use of an evaluation report by me or any third party.Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Corporate Clients Only Payment Method* Paypal Credit Card Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Total $0.00
