Evaluation Worksheet for Certificate		Home Health Aide
SID:	________________________________	Skills Certificate - 5077
		Effective: Fall 2014
		Health Sciences
Name:	________________________________	(707) 527-4272

REQUIREMENTS: Complete 1.5 units Home Health Aide Requirements - complete 1.5 units Course Description Units Completed In Progress Comments NRA 150B  Home Health Aide 1.5

	Evaluation worksheet completed upon receipt of Transfer Credit Evaluation form. Includes credit from other institutions only received to date.
	Evaluation worksheet completed for ________________________________. Includes all SRJC and transfer credit received to date.

Units completed:    __________ Units in progress:    __________ Total:    __________

Requirements Completed     Pending (work in progress)     Requirements Not Completed

Comments

Date: ________________________   By: ____________________________________________