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1 The International Qualifications Assessment Service (IQAS) assesses international educational documents and compares them to educational credentials in Canada. PLEASE COMPLETE STEPS 1-8, PRINT OUT AND SIGN The personal information collected on this form is collected under section 8(2) of the Government Organization Act and section 33(c) of the Freedom of Information and Protection of Privacy Act (FOIP Act). This information is necessary and directly related to our mandate to assess your educational documents and qualifications. The personal information we collect will be used only for assessment purposes. If you have questions about the collection of this information, you may contact the Director, International Qualifications Assessment Services (IQAS). Step 1 Personal Information Last or Family name: First name: Middle name(s): Names that appear on documents (if different from above please attach proof of name change, i.e. marriage certificate): Last or Family name: First name: Middle name(s): Mailing address: Apt. No. Street/Ave: City: Province / State: Postal / Zip code: Telephone (Home): Telephone (Work): address: Additional address: Birthdate (yyyy/mm/dd) Country of Birth: Gender: Male Female Country of Education Outside Canada (most recent): How did you learn about our service? (check all that apply) educational institution employer government office community/immigrant organization friend/relative professional association internet/website

2 Have you applied to IQAS for an assessment before? No Yes - File Number: You must include your past file number with your application. If you do not know your file number, please phone IQAS at Is this application a referral from an Alberta Career and Employment Counselor? No Yes Step 2 Educational History List all schools, colleges, institutes and universities attended, starting with the most recent: Name of Institution: Language of Instruction: From (yyyy/mm): To (yyyy/mm): Name of Certificate/Diploma/Degree: Name of Institution: Language of Instruction: From (yyyy/mm): To (yyyy/mm): Name of Certificate/Diploma/Degree: Name of Institution: Language of Instruction: From (yyyy/mm): To (yyyy/mm): Name of Certificate/Diploma/Degree: Please indicate if there have been any name changes to the institutions you have attended:

3 Step 3 Reason for Assessment Reason(s) for seeking an assessment (check all that apply). To support my application for immigration Seeking general employment Organization: Planning further studies/education Organization: Program: Other organization Organization: Step 4 Release of Assessment Results to other Institutions/Organizations Do you require an additional original assessment certificate sent directly to an institution/organization? No Yes Organization/Institution name: Program name (if applicable): Organization/Institution name: Program name (if applicable): Organization/Institution name: Program name (if applicable):

4 Step 5 Payment Calculation Please refer to the IQAS Application tutorial located at to select the appropriate type of assessment. ASSESSMENT TYPE Basic Assessment - $100 Useful for individuals seeking general employment. Used by many professional regulatory organizations, educational institutions and employers. Educational Institution Assessment - $100 Provides an evaluation for admission into many post-secondary educational institutions in Alberta, Saskatchewan and the Northwest Territories. Specialized Assessment - $200 Only used by specific educational institutions or professional regulatory organizations. Please see website for a list of institutions. How many additional degrees/credentials need to be assessed? ($75 for each additional degree/credential) Qty. x $75 COURIER FEE FOR RETURNING DOCUMENTS Please note, IQAS is NOT responsible for any documents that are lost in the mail. In Canada $10 (for documents returned to an address in Canada) Outside Canada $45 (for documents returned to an address outside Canada) ADDITIONAL ORIGINAL CERTIFICATE(S) Certificate(s) will be sent directly to institution/organization(s) listed in step 4 Qty. x $15 Additional Certificate(s) to be sent directly to the client Qty. x $15 TOTAL

5 Step 6 Payment TOTAL AMOUNT: Method of payment: Cheque /Money Order/Bank Draft [Payable to: The Minister of Finance (Canadian funds)] MasterCard Visa Credit Card Payments: Name of card holder: Card number: Expiration Date: (yyyy/mm): Note: International applicants should pay with a Money Order/Bank Draft or by Visa or MasterCard. A credit card number is only required if paying by Visa or MasterCard. Step 7 Declaration (Please read carefully and SIGN) I authorize the International Qualifications Assessment Service (IQAS) to carry out the procedures necessary for the evaluation of my file. This includes making copies of my records for the purpose of assessment and/or contacting the institutions stated on this application to verify the authenticity of my documents, and the institutions attended. I understand the assessment of my qualifications may be useful for employment or application to some post-secondary institutions but it does not guarantee employment, entrance to a profession or a post-secondary institution. I declare that all of the information and documentation is complete and that these documents have not been changed or altered in any way. In the event that IQAS determines that an educational document submitted for an evaluation has been altered, tampered or forged, IQAS will immediately cancel the assessment. IQAS will not issue a refund and will retain all educational documents submitted with the assessment request. IQAS reserves the right to share information on altered, tampered or forged documents with academic institutions, government agencies and other evaluation services. I hereby authorize and consent to the release of any or all information, documents or records which are in the possession of IQAS to all institutions / organizations that I have listed on this form. I further release IQAS from any liability resulting from the use of my assessment. I have read and understand the above and the information on this form and agree to the terms stated herein. Date signed (yyyy/mm/dd) Signature

6 Step 8 Application Checklist If any of the following required documents are missing, your application will be returned. I have enclosed the following items: IQAS Application Form completed and signed Payment of fees (cheque enclosed or credit card number in step 7) Original/certified copies of: Secondary school: diploma transcripts/mark sheets/grade reports Post Secondary: diploma(s)/degree(s) transcripts/mark sheets/grade reports Translations of all documents if they are not in English or French One photocopy of each educational document Proof of name change if your current name is different from the name on your educational documents (i.e. photocopy of marriage certificate or immigration document). IQAS IS A MAIL-IN SERVICE ONLY PLEASE MAIL YOUR COMPLETE APPLICATION VIA COURIER OR REGISTERED MAIL TO THE ADDRESS BELOW. International Qualifications Assessment Service (IQAS) 9th Floor, 108 Street Building, Street Edmonton, Alberta, Canada T5K 2J5 For more information on IQAS please visit our website or call our office. Individuals calling IQAS from: Edmonton phone: Alberta, but outside Edmonton phone: and ask for Saskatchewan phone: Northwest Territories phone: Canada and overseas phone: Alberta Service Centers IQAS applications and other related services are available to clients across the province of Alberta through any Alberta Service Center. For the location nearest you, please visit If applying for a Specialized Assessment include documents which show credits/hours of study (2011/01)

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