Evaluation Worksheet for Certificate		Advanced Cardiac Life Support
SID:	________________________________	Skills Certificate - 5022
		Effective: Fall 2022
		Public Safety
Name:	________________________________	(707) 524-1731

REQUIREMENTS: Complete 0.5 units Advanced Cardiac Life Support Requirements - complete 0.5 units Course Description Units Completed In Progress Comments EMC 116  Advanced Cardiac Life Support 0.5

	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: ____________________________________________